Provider Demographics
NPI:1093173593
Name:MICHELS, TIFFANY (MSED, LBA, BCBA,IBA)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:MICHELS
Suffix:
Gender:
Credentials:MSED, LBA, BCBA,IBA
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED, LBA, BCBA
Mailing Address - Street 1:208 HASTINGS LN
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3324
Mailing Address - Country:US
Mailing Address - Phone:252-621-1366
Mailing Address - Fax:833-901-0451
Practice Address - Street 1:208 HASTINGS LN
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3324
Practice Address - Country:US
Practice Address - Phone:252-621-1366
Practice Address - Fax:833-901-0451
Is Sole Proprietor?:No
Enumeration Date:2016-01-29
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0134000145103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst