Provider Demographics
NPI:1871119933
Name:DALE, TIFFANI MICHELLE (MED, LPC)
Entity type:Individual
Prefix:MS
First Name:TIFFANI
Middle Name:MICHELLE
Last Name:DALE
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:PINEY VIEW
Mailing Address - State:WV
Mailing Address - Zip Code:25906-0175
Mailing Address - Country:US
Mailing Address - Phone:304-992-1665
Mailing Address - Fax:
Practice Address - Street 1:111 CORAL COURT, APT 5
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801
Practice Address - Country:US
Practice Address - Phone:304-922-1665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2157101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional