Individual
DR. TIFFANY FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
EDD, NCC, LCPC
Contact information
Practice address
9470 ANNAPOLIS RD # 114, LANHAM, MD 20706-3025
(301) 204-9677
Mailing address
9470 ANNAPOLIS RD # 114, LANHAM, MD 20706-3025
(301) 204-9677
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LC9407
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
459007400
—
MD
Enumeration date
03/19/2019
Last updated
11/15/2019
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