Provider Demographics
NPI:1487163762
Name:TIFFANY, MEEGAN A (MA, LPCA, NCC)
Entity type:Individual
Prefix:
First Name:MEEGAN
Middle Name:A
Last Name:TIFFANY
Suffix:
Gender:F
Credentials:MA, LPCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5704
Mailing Address - Country:US
Mailing Address - Phone:919-697-1969
Mailing Address - Fax:
Practice Address - Street 1:7810 BALLANTYNE COMMONS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3416
Practice Address - Country:US
Practice Address - Phone:704-995-3434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12751101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health