Provider Demographics
NPI:1568449346
Name:HUSACK, TIFFANY SANDS (LPC)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:SANDS
Last Name:HUSACK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 OBERLIN DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-1630
Mailing Address - Country:US
Mailing Address - Phone:919-593-0577
Mailing Address - Fax:919-321-0394
Practice Address - Street 1:180 PROVIDENCE RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2206
Practice Address - Country:US
Practice Address - Phone:919-593-0577
Practice Address - Fax:919-321-0394
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3488101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional