Healthcare Provider Details

I. General information

NPI: 1164984902
Provider Name (Legal Business Name): TIFFANY MARIE BERNIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIFFANY MARIE BORBON

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8215 FOREST POINT BLVD STE 150
CHARLOTTE NC
28273-0219
US

IV. Provider business mailing address

335 DOGGETT ST APT 214
CHARLOTTE NC
28203-6413
US

V. Phone/Fax

Practice location:
  • Phone: 980-422-5887
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number4375
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: