Provider Demographics
NPI:1568165488
Name:BURNETTE, TIFFANY ANN (MT-BC, CFLE-P, BCC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANN
Last Name:BURNETTE
Suffix:
Gender:F
Credentials:MT-BC, CFLE-P, BCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 DALGARVEN DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-3944
Mailing Address - Country:US
Mailing Address - Phone:919-579-9663
Mailing Address - Fax:
Practice Address - Street 1:1312 DALGARVEN DR
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-3944
Practice Address - Country:US
Practice Address - Phone:919-579-9663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X, 101YP2500X, 106S00000X, 171400000X, 174H00000X, 225A00000X
NCCPS-21125405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator
No405300000XOther Service ProvidersPrevention Professional