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General NPI Number Information
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NPI Number | 1720982259
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Entity Type | Individual
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Provider Name | TIFFANY DEVAUGHAN
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Gender | Female
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Dates
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Enumeration Date | 10/07/2026
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Last Update Date | 10/07/2026
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Provider Practice Location Address
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Address Line | 1591 S IRBY ST
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City | FLORENCE
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State | SC
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Zip | 29505-3409
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Country | US
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Telephone | 843-206-0845
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Fax | 843-407-3261
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Provider Business Mailing Address
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Address Line | 4600 MONTGOMERY RD STE 400
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City | CINCINNATI
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State | OH
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Zip | 45212-2600
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Country | US
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Telephone |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CSIP03920
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ADC-2302
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License Number State | SC
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