Provider Demographics
NPI:1962069294
Name:DICKSON, TIFFANY LEE (MSW)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:LEE
Last Name:DICKSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:LEE
Other - Last Name:GUIDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:4880 NORTH HWY 19A SUITE 200
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-2018
Mailing Address - Country:US
Mailing Address - Phone:352-589-8111
Mailing Address - Fax:352-589-8495
Practice Address - Street 1:4880 NORTH HWY 19A SUITE 200
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2018
Practice Address - Country:US
Practice Address - Phone:352-589-8111
Practice Address - Fax:352-589-8495
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker