Provider Demographics
NPI:1427454578
Name:ANDERSON-WASHINGTON, TIFFANY C (LPC, DPC)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:C
Last Name:ANDERSON-WASHINGTON
Suffix:
Gender:F
Credentials:LPC, DPC
Other - Prefix:DR
Other - First Name:TIFFANY
Other - Middle Name:C
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, DPC
Mailing Address - Street 1:3450 HIGHWAY 80 W
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39209-7201
Mailing Address - Country:US
Mailing Address - Phone:601-321-2400
Mailing Address - Fax:601-321-2476
Practice Address - Street 1:3450 HIGHWAY 80 W
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39209-7201
Practice Address - Country:US
Practice Address - Phone:601-321-2400
Practice Address - Fax:601-321-2476
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1664101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional