Provider Demographics
NPI:1194120857
Name:GOSSETT, TIFFANY CHERIE (LPC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:CHERIE
Last Name:GOSSETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 RAINBOW LN
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:GA
Mailing Address - Zip Code:31569-4053
Mailing Address - Country:US
Mailing Address - Phone:706-951-3801
Mailing Address - Fax:
Practice Address - Street 1:2712 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4727
Practice Address - Country:US
Practice Address - Phone:912-265-7382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008082101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional