Provider Demographics
NPI:1396247284
Name:TOLIVER, TIFFANY NICOLE (LMSW)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:NICOLE
Last Name:TOLIVER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3914 PIXLEY DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71109-8202
Mailing Address - Country:US
Mailing Address - Phone:318-458-5370
Mailing Address - Fax:
Practice Address - Street 1:809 POLK ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:LA
Practice Address - Zip Code:71052-2452
Practice Address - Country:US
Practice Address - Phone:318-871-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker