Provider Demographics
NPI:1396090130
Name:CHEPKE, TIFFANY CHRISTINE (LCSW)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:CHRISTINE
Last Name:CHEPKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:CHRISTINE
Other - Last Name:BUIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1585 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:GOLD HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28071-0041
Mailing Address - Country:US
Mailing Address - Phone:704-213-2444
Mailing Address - Fax:
Practice Address - Street 1:1585 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:GOLD HILL
Practice Address - State:NC
Practice Address - Zip Code:28071-6656
Practice Address - Country:US
Practice Address - Phone:704-213-2444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0078321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical