Provider Demographics
NPI:1851480495
Name:MCDONALD, TIFFANY S (LPC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:S
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:S
Other - Last Name:ROTTIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 1082
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31598-1082
Mailing Address - Country:US
Mailing Address - Phone:912-427-3456
Mailing Address - Fax:912-427-3457
Practice Address - Street 1:305 TY TY ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-1267
Practice Address - Country:US
Practice Address - Phone:912-427-3456
Practice Address - Fax:912-427-3457
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003750101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor