Tiffany Marie Willingham, SUDRC

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

18573 Issued in CA

Practice address

671 Governor St
Costa Mesa, CA 92627-2504

Phone

(949) 343-6565

NPI assigned

Aug 16, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1723766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765843200000",
    "number": "1699507814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14400 NEWPORT AVE APT 91",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927805624",
            "telephone_number": "949-343-6566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "671 GOVERNOR ST",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926272504",
            "telephone_number": "949-343-6565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLINGHAM",
        "first_name": "TIFFANY",
        "middle_name": "MARIE",
        "credential": "SUDRC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-08-16",
        "last_updated": "2025-12-16",
        "certification_date": "2025-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "CA",
            "license": "18573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaylin Williams
• Madison Marie Williams
• Maritza Gabriella Williams
• Onesa Antanay Williams, B.A.
• Simone Jonee Williams
• Willow Birth Village LLC
• Amy Rebecca Wilson, BCBA
• Ashley Ayanna Wilson, BA
• Julia Margaret Wilson
• Kelly Diane Wilson, MS, ATC

• Peer Specialist in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Peer Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.