Provider Demographics
NPI:1801430368
Name:WHITEHURST, TIFFANY MICHELLE
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MICHELLE
Last Name:WHITEHURST
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 1:115 HIGHLAND BLVD APT C
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-6932
Mailing Address - Country:US
Mailing Address - Phone:302-480-8668
Mailing Address - Fax:
Practice Address - Street 1:314 E MAIN ST STE 403
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7182
Practice Address - Country:US
Practice Address - Phone:302-369-3533
Practice Address - Fax:302-369-3093
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000874101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health