Provider Demographics
NPI:1891525317
Name:WALKER, TIFFANY RENEE (MDIV, MSW)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:RENEE
Last Name:WALKER
Suffix:
Gender:F
Credentials:MDIV, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 NEWNAN CROSSING BLVD E APT 1308
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2357
Mailing Address - Country:US
Mailing Address - Phone:502-309-5918
Mailing Address - Fax:
Practice Address - Street 1:2050 NEWNAN CROSSING BLVD E APT 1308
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2357
Practice Address - Country:US
Practice Address - Phone:502-309-5918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling