Provider Demographics
NPI:1679868228
Name:WILSON, TIFFANY A (MS, LPCA, NCC)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:A
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS, LPCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 W MEADOWVIEW RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-3406
Mailing Address - Country:US
Mailing Address - Phone:336-285-7173
Mailing Address - Fax:336-285-7174
Practice Address - Street 1:2216 W MEADOWVIEW RD
Practice Address - Street 2:SUITE 110
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3406
Practice Address - Country:US
Practice Address - Phone:336-285-7173
Practice Address - Fax:336-285-7174
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8735101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor