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General NPI Number Information
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NPI Number | 1578163101
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Entity Type | Individual
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Provider Name | TIFFANY GATEWOOD NCC, LCMHC
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Gender | Female
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Dates
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Enumeration Date | 11/01/2020
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 13420 REESE BLVD W
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-7925
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Country | US
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Telephone | 980-247-0682
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Fax |
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Provider Business Mailing Address
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Address Line | 8310 GRAHAM RD
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City | DENVER
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State | NC
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Zip | 28037-8606
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Country | US
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Telephone | 704-804-8950
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A16124
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A16124
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License Number State | KY
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