Provider Demographics
NPI:1376240747
Name:RAINES, TIFFANI (LCSW)
Entity Type:Individual
Prefix:
First Name:TIFFANI
Middle Name:
Last Name:RAINES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 RAWDON DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-1408
Mailing Address - Country:US
Mailing Address - Phone:910-260-1058
Mailing Address - Fax:
Practice Address - Street 1:3520 RAWDON DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-1408
Practice Address - Country:US
Practice Address - Phone:910-260-1058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC014864101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional