Provider Demographics
NPI:1487209912
Name:DORSEY, TIFFANY ROSE (MED,LICDC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ROSE
Last Name:DORSEY
Suffix:
Gender:F
Credentials:MED,LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 SANDPIPER TRL SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-5706
Mailing Address - Country:US
Mailing Address - Phone:330-503-4554
Mailing Address - Fax:
Practice Address - Street 1:5701 BURNETT RD
Practice Address - Street 2:
Practice Address - City:LEAVITTSBURG
Practice Address - State:OH
Practice Address - Zip Code:44430-9713
Practice Address - Country:US
Practice Address - Phone:330-503-4554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.162874101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)