Provider Demographics
NPI:1619786100
Name:SULLIVAN, TIFFANY DIANA (MS, LPC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DIANA
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8875 RIDGE AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2000
Mailing Address - Country:US
Mailing Address - Phone:267-257-6286
Mailing Address - Fax:
Practice Address - Street 1:3535 MARKET ST FL 5
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3345
Practice Address - Country:US
Practice Address - Phone:215-746-4110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC016598101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health