Provider Demographics
NPI:1124256763
Name:CONYERS, TIFFANY (LCSW, LISW-CP, PMH-C)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:
Last Name:CONYERS
Suffix:
Gender:F
Credentials:LCSW, LISW-CP, PMH-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 MEETING ST
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-7308
Mailing Address - Country:US
Mailing Address - Phone:803-233-3199
Mailing Address - Fax:803-233-8420
Practice Address - Street 1:603 NEWTON RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2952
Practice Address - Country:US
Practice Address - Phone:803-414-4819
Practice Address - Fax:803-233-8420
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0056011041C0700X
SC121221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11937021OtherCAQH