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NPI Code Detail

MEDICARE: TIFFANY THOMPSON

MEDICARE:   TIFFANY  THOMPSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1164811667
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY THOMPSON
Provider Business Mailing Address
First Line : 2222 CANDLELIGHT WOODS DR
Second Line :
City : MATTHEWS
State : NC
Zip : 28105-4900
Country : US
Telephone Number : 704-230-6157
Fax Number :
Provider Business Practice Location Address
First Line : 4415 MONROE RD
Second Line : SUITE 100
City : CHARLOTTE
State : NC
Zip : 28205-7754
Country : US
Telephone Number : 704-332-3634
Fax Number : 704-332-1801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2015
Last Update Date : 01/21/2015

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Directions to “ TIFFANY THOMPSON ” Practice Location

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