Provider Information for 1275056624
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TIFFANY POLITE HENDERSON LPC, NCC
Sex: Female
NPI: 1275056624
Last Updated: 2023-02-22
Certification Date: 2023-02-22
Certification Date: 2023-02-22
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1275056624 | ||||||||||||
| Enumeration Date | 2017-07-18 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 152 WOODRUFF DR SLIDELL, LA 70461-4181 United States Phone: 504-230-4310 | Fax: | ||||||||||||
| Primary Practice Address | 2901 RIDGELAKE DR STE 104 METAIRIE, LA 70002-4946 United States Phone: 504-230-4310 | Fax: | ||||||||||||
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