Provider Demographics
NPI:1831976885
Name:KITCHING, TIFFANI
Entity type:Individual
Prefix:
First Name:TIFFANI
Middle Name:
Last Name:KITCHING
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25149 MARSH CREEK BLVD APT 103
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-6513
Mailing Address - Country:US
Mailing Address - Phone:313-695-1208
Mailing Address - Fax:
Practice Address - Street 1:3200 E EISENHOWER PKWY
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-3231
Practice Address - Country:US
Practice Address - Phone:734-677-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician