Provider Demographics
NPI:1679086490
Name:DUNCAN, TIPHANY (LCDC III)
Entity type:Individual
Prefix:
First Name:TIPHANY
Middle Name:
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:LCDC III
Other - Prefix:
Other - First Name:TIPHANY
Other - Middle Name:
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCDC III
Mailing Address - Street 1:1822 LEETH CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45690-9242
Mailing Address - Country:US
Mailing Address - Phone:740-835-1829
Mailing Address - Fax:
Practice Address - Street 1:14572 US HIGHWAY 23
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-9373
Practice Address - Country:US
Practice Address - Phone:740-648-9250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.161978101YA0400X
OHLCDCIII.161866101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)