| Doctor Name: | TIFFANY BLACKWELL |
| NPI Number: | 1184049728 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCPC, LCADC |
| License Number: | LCA1916 |
| Business Practice Address: | 703 Sudbrook Rd Pikesville, MD - 212084761 |
| Business Phone Number: | 4436776813 |
| Business Fax Number: | |
| Mailing Address: | 703 Sudbrook Rd, PIKESVILLE |
| State: | MD |
| Postal Code: | 212084761 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 02/19/2014 |
| NPI Last Update Date: | 02/19/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | LCA1916 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |