Individual
TIFFANY NICOLE PROVIDENTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LGSW
Contact information
Practice address
1 KENTON DR, CHARLESTON, WV 25311-1256
(503) 513-3495
(800) 734-8498
Mailing address
1005 WHITE WILLOW WAY, MORGANTOWN, WV 26505-6119
(508) 663-3852
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
BP00946994
WV
104100000X
Social Worker
SW072417193
WV
Other
Enumeration date
08/08/2024
Last updated
03/30/2025
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