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NPI Code Detail

MEDICARE: BREANNA TIFFANY ELLIOTT LCAS-R

MEDICARE: BREANNA TIFFANY ELLIOTT LCAS-R
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
1101YA0400XAddiction (Substance Use Disorder) CounselorLCAS-26280NC

General Provider Information

NPI Number : 1710512868
Entity Type Code : Individual
Provider Name (Legal Business Name) : BREANNA TIFFANY ELLIOTT LCAS-R
Provider Business Mailing Address
First Line : 309 BUBBLING BROOK LN
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28546-4653
Country : US
Telephone Number : 433-912-2024
Fax Number :
Provider Business Practice Location Address
First Line : 806 BELL FORK RD
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28540-6312
Country : US
Telephone Number : 910-347-2205
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2020
Last Update Date : 11/27/2023

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