Individual
TIFFANY DULAMAL NISWONGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1904 EASTERN PKWY, LOUISVILLE, KY 40204-1452
(502) 694-9488
Mailing address
6705 WILD FOX LN, PROSPECT, KY 40059-9479
(912) 484-2858
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
255256
KY
Other
Enumeration date
08/27/2021
Last updated
08/27/2021
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