Provider Demographics
NPI:1730230095
Name:STARNES, TIFFANY BRYAN (MED, NCC, LPC)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:BRYAN
Last Name:STARNES
Suffix:
Gender:F
Credentials:MED, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-1441
Mailing Address - Country:US
Mailing Address - Phone:404-366-3420
Mailing Address - Fax:404-608-1365
Practice Address - Street 1:1035 MAIN ST
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-1441
Practice Address - Country:US
Practice Address - Phone:404-366-3420
Practice Address - Fax:404-608-1365
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0003444101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50161OtherNCC