Provider Demographics
NPI:1285108795
Name:HETZLER, TIFFANY ESPINOSA (LPC, NCC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ESPINOSA
Last Name:HETZLER
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 ASHTON DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4208
Mailing Address - Country:US
Mailing Address - Phone:770-330-2026
Mailing Address - Fax:
Practice Address - Street 1:1845 PEELER RD STE C
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-5710
Practice Address - Country:US
Practice Address - Phone:770-330-2026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011182101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health