Provider Demographics
NPI:1609699503
Name:DIAL, TIFFANY NICOLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:NICOLE
Last Name:DIAL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 GRAND BLVD APT 2522
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2664
Mailing Address - Country:US
Mailing Address - Phone:240-304-7526
Mailing Address - Fax:
Practice Address - Street 1:200 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-5984
Practice Address - Country:US
Practice Address - Phone:443-984-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool