Provider Demographics
NPI:1184894834
Name:HALL, TIFFANY
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 STONE LION DR
Mailing Address - Street 2:APT 735
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6171
Mailing Address - Country:US
Mailing Address - Phone:336-953-4219
Mailing Address - Fax:
Practice Address - Street 1:700 STONE LION DR
Practice Address - Street 2:APT 735
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-6171
Practice Address - Country:US
Practice Address - Phone:336-953-4219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10403101YM0800X
NC3555-A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)