Healthcare Provider Details

I. General information

NPI: 1245929561
Provider Name (Legal Business Name): TIFFIANY S HAYWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 11/27/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 W BRISTOL RD
FLINT MI
48507-5516
US

IV. Provider business mailing address

329 LETA AVE
FLINT MI
48507-2727
US

V. Phone/Fax

Practice location:
  • Phone: 810-496-5562
  • Fax:
Mailing address:
  • Phone: 601-896-7656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number6801115751
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number6801115751
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number6801115751
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801115751
License Number State
# 6
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number6801115751
License Number StateMI
# 7
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801115751
License Number StateMI
# 8
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number6801115751
License Number StateMI
# 9
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6801115751
License Number StateMI
# 10
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6801115751
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: