1619585049 NPI number — TIFFANY DAVEE SMITH THOMAS LCSW

Table of content: TIFFANY DAVEE SMITH THOMAS LCSW (NPI 1619585049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619585049 NPI number — TIFFANY DAVEE SMITH THOMAS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
TIFFANY
Provider Middle Name:
DAVEE SMITH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMAS
Provider Other First Name:
TIFFANY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1619585049
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11052
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27116-1052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-422-7949
Provider Business Mailing Address Fax Number:
336-753-3695

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PO BOX 11052
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27116-1052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-422-7949
Provider Business Practice Location Address Fax Number:
336-753-3695
Provider Enumeration Date:
07/22/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  C019306 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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