Provider Demographics
NPI:1982259537
Name:SIMPSON, TIFFINI MARIA
Entity Type:Individual
Prefix:
First Name:TIFFINI
Middle Name:MARIA
Last Name:SIMPSON
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 1:2205 WOODLEAF RD APT 6F
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-1181
Mailing Address - Country:US
Mailing Address - Phone:704-919-9982
Mailing Address - Fax:336-450-1626
Practice Address - Street 1:3113 MCCONNELL RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-9611
Practice Address - Country:US
Practice Address - Phone:336-355-7082
Practice Address - Fax:336-450-1626
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-1180320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities