Provider Demographics
NPI:1700437613
Name:ELLER, TIFFANY NICOLE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:NICOLE
Last Name:ELLER
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 1:3325 DURHAM CHAPEL HILL BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2646
Mailing Address - Country:US
Mailing Address - Phone:919-338-0939
Mailing Address - Fax:984-888-0913
Practice Address - Street 1:3325 DURHAM CHAPEL HILL BLVD STE 210
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2646
Practice Address - Country:US
Practice Address - Phone:919-338-0939
Practice Address - Fax:984-888-0913
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0138561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical