Provider Demographics
NPI:1457124992
Name:CHAMBERS, TIFANY (BSW, QP, CPSS)
Entity Type:Individual
Prefix:
First Name:TIFANY
Middle Name:
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:BSW, QP, CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 WALNUTWOOD DR
Mailing Address - Street 2:APT. 105
Mailing Address - City:WHITSETT
Mailing Address - State:NC
Mailing Address - Zip Code:27377
Mailing Address - Country:US
Mailing Address - Phone:828-781-1513
Mailing Address - Fax:
Practice Address - Street 1:3911 SLADE RD
Practice Address - Street 2:
Practice Address - City:BLANCH
Practice Address - State:NC
Practice Address - Zip Code:27212-9107
Practice Address - Country:US
Practice Address - Phone:828-781-1513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NC175T00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist