Provider Demographics
NPI:1346948973
Name:WELCH, TIFFANY ANNE (RBT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANNE
Last Name:WELCH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 FORT HOWELL DR
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2764
Mailing Address - Country:US
Mailing Address - Phone:843-540-5559
Mailing Address - Fax:
Practice Address - Street 1:200 BURNT CHURCH RD
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6412
Practice Address - Country:US
Practice Address - Phone:843-540-5559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRBT-21-176380106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-21-176380OtherBACB