Provider Demographics
NPI:1871808550
Name:TIFT & TIFT LLC
Entity type:Organization
Organization Name:TIFT & TIFT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:TIFT
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:912-977-4663
Mailing Address - Street 1:36 COATES RD
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-1013
Mailing Address - Country:US
Mailing Address - Phone:912-977-4663
Mailing Address - Fax:912-369-6530
Practice Address - Street 1:36 COATES RD
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313
Practice Address - Country:US
Practice Address - Phone:912-977-4663
Practice Address - Fax:912-369-6530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI012789101YA0400X
GAMSW0026561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty