Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) |
NPI | 1417545781 |
---|---|
Provider Name | Tiffany Mcdermid |
First Address | Warner Robins, GA 31088-1251 |
Second Address | Warner Robins, GA 31088-7690 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2021 |
Last Update Date | 04/01/2021 |