Provider Demographics
NPI:1609303114
Name:CASTILLE, TIFFANY NICOLE (LMSW)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:NICOLE
Last Name:CASTILLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:SNIDARICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 STONERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DUSON
Mailing Address - State:LA
Mailing Address - Zip Code:70529-3950
Mailing Address - Country:US
Mailing Address - Phone:763-222-3414
Mailing Address - Fax:
Practice Address - Street 1:1200 S ACADIAN THRUWAY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6900
Practice Address - Country:US
Practice Address - Phone:763-222-3414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-15
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 171M00000X
LA17386104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker