Provider Demographics
NPI:1366761900
Name:DAVIS, TIFFANY VANEICE (MS)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:VANEICE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 S HULL ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36104-4275
Mailing Address - Country:US
Mailing Address - Phone:334-269-4156
Mailing Address - Fax:334-269-4157
Practice Address - Street 1:423 S HULL ST
Practice Address - Street 2:SUITE 204
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36104-4275
Practice Address - Country:US
Practice Address - Phone:334-269-4156
Practice Address - Fax:334-269-4157
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor