Provider Demographics
NPI:1548895816
Name:GRAHAM, TIFFANY E (RCSWI, MSW)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:E
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:RCSWI, MSW
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:E
Other - Last Name:ASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RCSWI, MSW
Mailing Address - Street 1:6705 BULRUSH CT
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33413-3486
Mailing Address - Country:US
Mailing Address - Phone:321-591-1246
Mailing Address - Fax:
Practice Address - Street 1:6705 BULRUSH CT
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33413-3486
Practice Address - Country:US
Practice Address - Phone:321-591-1246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-07
Last Update Date:2020-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW13152101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor