Provider Demographics
NPI:1447623814
Name:LAND, TIFFANY (LCPC)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:
Last Name:LAND
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 REDMORE CT
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-2406
Mailing Address - Country:US
Mailing Address - Phone:410-596-4053
Mailing Address - Fax:
Practice Address - Street 1:6325 WOODSIDE CT STE 350
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1042
Practice Address - Country:US
Practice Address - Phone:410-910-9660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-07
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3659101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional