Provider Demographics
NPI:1720829997
Name:DILLARD, TIFFANY MCLAIN
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MCLAIN
Last Name:DILLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CAMBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-4214
Mailing Address - Country:US
Mailing Address - Phone:601-942-4595
Mailing Address - Fax:
Practice Address - Street 1:33 CAMBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-4214
Practice Address - Country:US
Practice Address - Phone:601-942-4595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health