Provider Demographics
NPI:1679315923
Name:AUGUSTINE, TIFFANY (PSYD, LCP)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:AUGUSTINE
Suffix:
Gender:F
Credentials:PSYD, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 KINGS MANOR DR APT 9134
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3081
Mailing Address - Country:US
Mailing Address - Phone:337-224-2151
Mailing Address - Fax:
Practice Address - Street 1:9407 CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:NEW KENT
Practice Address - State:VA
Practice Address - Zip Code:23124-2029
Practice Address - Country:US
Practice Address - Phone:804-966-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-08
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810008525103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical