Provider Demographics
NPI:1295236149
Name:BUFORT-ODOM, TIFFANY (MS, NCC, LPC)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:
Last Name:BUFORT-ODOM
Suffix:
Gender:F
Credentials:MS, NCC, LPC
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:BUFORT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, NCC, LPC
Mailing Address - Street 1:3261 OLD WASHINGTON RD STE 2031
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3313
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5200 2ND ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-6622
Practice Address - Country:US
Practice Address - Phone:202-519-9997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC15525101YP2500X
PAPC009875101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional