Provider Demographics
NPI:1295081560
Name:COTTEN, TIFFANIE GAMBRELL (MSW,LCSW-A)
Entity type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:GAMBRELL
Last Name:COTTEN
Suffix:
Gender:F
Credentials:MSW,LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 LAKE BOONE TRL STE 100
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-2994
Mailing Address - Country:US
Mailing Address - Phone:919-600-9665
Mailing Address - Fax:919-256-0781
Practice Address - Street 1:3801 LAKE BOONE TRL STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-2994
Practice Address - Country:US
Practice Address - Phone:919-600-9665
Practice Address - Fax:919-256-0781
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NCP0132121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)