Healthcare Provider Details

I. General information

NPI: 1568165488
Provider Name (Legal Business Name): TIFFANY ANN BURNETTE MT-BC, BCC, CADC-I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2172 N SALEM ST STE 105
APEX NC
27523-6457
US

IV. Provider business mailing address

1312 DALGARVEN DR
APEX NC
27502-3944
US

V. Phone/Fax

Practice location:
  • Phone: 919-629-4360
  • Fax: 919-629-4362
Mailing address:
  • Phone: 919-579-9663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License NumberCPS-21125
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: