Provider Demographics
NPI:1316551484
Name:WRIGHT, TIFFANIE L (LPC)
Entity type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:L
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TIFFANIE
Other - Middle Name:L
Other - Last Name:BRANTLEY-WRIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:755 JW WARREN RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31027-4792
Mailing Address - Country:US
Mailing Address - Phone:470-526-8043
Mailing Address - Fax:
Practice Address - Street 1:3133 GOLF RIDGE BLVD STE 304
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1995
Practice Address - Country:US
Practice Address - Phone:470-526-8043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011658101YM0800X, 101YP2500X
101YP2500X, 101YS0200X, 101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101Y00000XBehavioral Health & Social Service ProvidersCounselor