Provider Demographics
NPI:1548936776
Name:HARVEY, TIFFANY L (LPC, NBCC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:L
Last Name:HARVEY
Suffix:
Gender:F
Credentials:LPC, NBCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-6211
Mailing Address - Country:US
Mailing Address - Phone:804-218-4149
Mailing Address - Fax:
Practice Address - Street 1:201 S LAKE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-6211
Practice Address - Country:US
Practice Address - Phone:804-218-4149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010730101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional