Provider Demographics
NPI:1932535135
Name:MCCORMICK, TIFFANI (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:TIFFANI
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 POINT CROSSING PL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-4652
Mailing Address - Country:US
Mailing Address - Phone:910-964-9347
Mailing Address - Fax:
Practice Address - Street 1:3117 POPLARWOOD CT STE 350
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-6446
Practice Address - Country:US
Practice Address - Phone:919-790-8580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0157061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical