MEDICARE: TIFFANY SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1649084005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY SMITH

Provider Business Mailing Address
First Line	:	1103 NOLAN ST
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22401-5359
Country	:	US
Telephone Number	:	804-252-1748
Fax Number	:

Provider Business Practice Location Address
First Line	:	6334 PETERS CREEK RD
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24019-4024
Country	:	US
Telephone Number	:	540-348-4700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2025
Last Update Date	:	02/05/2025

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Directions to “ TIFFANY SMITH ” Practice Location

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