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NPI Code Detail

MEDICARE: TIFFANY LARAY DENNIS LPC, MS

MEDICARE: TIFFANY LARAY DENNIS LPC, MS
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
1101YP2500XProfessional CounselorLPC013304GA

General Provider Information

NPI Number : 1861037616
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY LARAY DENNIS LPC, MS
Provider Business Mailing Address
First Line : 550 NORTHRIDGE PKWY APT 1411
Second Line :
City : SANDY SPRINGS
State : GA
Zip : 30350-3401
Country : US
Telephone Number : 803-840-3763
Fax Number :
Provider Business Practice Location Address
First Line : 5887 GLENRIDGE DR STE 230
Second Line :
City : ATLANTA
State : GA
Zip : 30328-9929
Country : US
Telephone Number : 770-410-8107
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2019
Last Update Date : 11/15/2022

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