Provider Demographics
NPI:1992415665
Name:CARABALLO, TIFFANY S
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:S
Last Name:CARABALLO
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 1:4980 LEESBURG PIKE APT 206
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1110
Mailing Address - Country:US
Mailing Address - Phone:228-324-2118
Mailing Address - Fax:
Practice Address - Street 1:20116 ASHBROOK PL STE 110
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5086
Practice Address - Country:US
Practice Address - Phone:480-660-8757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional