Healthcare Provider Details

I. General information

NPI: 1770884934
Provider Name (Legal Business Name): TIFFANY HOUCHINS BA, MA.C., LA.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SULGRAVE AVE SUITE 305
BALTIMORE MD
21209-3654
US

IV. Provider business mailing address

3228 KESWICK RD
BALTIMORE MD
21211-2738
US

V. Phone/Fax

Practice location:
  • Phone: 410-542-2010
  • Fax:
Mailing address:
  • Phone: 443-538-9023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberUO1851
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: