Provider Demographics
NPI:1588119549
Name:COMPTON, TIFFANY JOVANTE (LCMHC LCAS-A)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:JOVANTE
Last Name:COMPTON
Suffix:
Gender:F
Credentials:LCMHC LCAS-A
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:EDMUNDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1503 WAYNE MEMORIAL DR STE E
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-2203
Mailing Address - Country:US
Mailing Address - Phone:919-587-0001
Mailing Address - Fax:919-587-0007
Practice Address - Street 1:1503 WAYNE MEMORIAL DR STE E
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-2203
Practice Address - Country:US
Practice Address - Phone:919-587-0001
Practice Address - Fax:919-587-0007
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-28546101YA0400X
NC12407101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)