Healthcare Provider Details

I. General information

NPI: 1346120342
Provider Name (Legal Business Name): MS. TIFFANY CAMILLE HUTCHINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 10/24/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WAXHAW PROFESSIONAL PARK DR STE H
WAXHAW NC
28173-5018
US

IV. Provider business mailing address

105 WAXHAW PROFESSIONAL PARK DR STE H
WAXHAW NC
28173-5018
US

V. Phone/Fax

Practice location:
  • Phone: 704-222-0232
  • Fax: 704-256-9968
Mailing address:
  • Phone: 704-350-5087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP020225
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number1232123
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: