Provider Demographics
NPI:1568740348
Name:SOLTER, TIFFANY DAWN (MA)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:DAWN
Last Name:SOLTER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:DAWN
Other - Last Name:POULIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHP, CDP
Mailing Address - Street 1:PO BOX 918
Mailing Address - Street 2:
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512
Mailing Address - Country:US
Mailing Address - Phone:843-544-4060
Mailing Address - Fax:206-901-2010
Practice Address - Street 1:1035 CHERAW HWY
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512
Practice Address - Country:US
Practice Address - Phone:843-544-4060
Practice Address - Fax:206-302-2210
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CP00004297101YA0400X
CG60204032101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC405127Medicaid