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NPI Code Detail

MEDICARE: TIFFANEY NICOLE WILLIAMS-FULLER LCMHC

MEDICARE: TIFFANEY NICOLE WILLIAMS-FULLER LCMHC
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
1101YP2500XProfessional Counselor14029NC
2103TC1900XCounseling Psychologist14029NC
3101YM0800XMental Health Counselor14029NC

General Provider Information

NPI Number : 1962166991
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANEY NICOLE WILLIAMS-FULLER LCMHC
Provider Business Mailing Address
First Line : PO BOX 19305
Second Line :
City : CHARLOTTE
State : NC
Zip : 28219-9305
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 501 BILLINGSLEY RD
Second Line : STE B
City : CHARLOTTE
State : NC
Zip : 28211-1009
Country : US
Telephone Number : 704-444-2400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2021
Last Update Date : 12/23/2025

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Directions to “ TIFFANEY NICOLE WILLIAMS-FULLER LCMHC” Practice Location

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