Provider Demographics
NPI:1467955161
Name:CUTRONE, TIFFANY (LCMHC, LPC, LCAS)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:CUTRONE
Suffix:
Gender:F
Credentials:LCMHC, LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 GUM BRANCH RD STE 138H
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-6262
Mailing Address - Country:US
Mailing Address - Phone:910-356-6550
Mailing Address - Fax:
Practice Address - Street 1:332 CATAMARAN RD
Practice Address - Street 2:
Practice Address - City:SWANSBORO
Practice Address - State:NC
Practice Address - Zip Code:28584-2505
Practice Address - Country:US
Practice Address - Phone:631-860-1168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-09
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011682101YM0800X, 101YP2500X
NC13771101YM0800X
NCA13771101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health