Provider Demographics
NPI:1104280932
Name:WILLIAMS, TIFFANY DENISE (THERAPIST)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DENISE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:THERAPIST
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:DENISE
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:THERAPIST
Mailing Address - Street 1:9825 MAGNOLIA AVE
Mailing Address - Street 2:SUITE B, PMB 322
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3562
Mailing Address - Country:US
Mailing Address - Phone:951-509-2499
Mailing Address - Fax:
Practice Address - Street 1:9890 COUNTY FARM RD STE 2
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3678
Practice Address - Country:US
Practice Address - Phone:951-509-2499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
CA3529101YM0800X, 1041C0700X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical