Provider Demographics
NPI:1508132853
Name:O'TOOLE, TIFFANY LEIGH (MA, LPCA, NCC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LEIGH
Last Name:O'TOOLE
Suffix:
Gender:F
Credentials:MA, LPCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12189
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28561-2189
Mailing Address - Country:US
Mailing Address - Phone:252-633-3855
Mailing Address - Fax:252-633-1548
Practice Address - Street 1:2117 S GLENBURNIE RD STE 15-16
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2280
Practice Address - Country:US
Practice Address - Phone:252-633-3855
Practice Address - Fax:252-633-1548
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9345101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health