Provider Demographics
NPI:1568165488
Name:BURNETTE, TIFFANY ANN (MT-BC, BCC, CADC-I)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANN
Last Name:BURNETTE
Suffix:
Gender:F
Credentials:MT-BC, BCC, CADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 DALGARVEN DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-3944
Mailing Address - Country:US
Mailing Address - Phone:919-579-9663
Mailing Address - Fax:
Practice Address - Street 1:2172 N SALEM ST STE 105
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27523-6457
Practice Address - Country:US
Practice Address - Phone:919-629-4360
Practice Address - Fax:919-629-4362
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 174H00000X, 225A00000X, 101YA0400X, 174H00000X, 225A00000X
NCCPS-21125405300000X, 405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator
No405300000XOther Service ProvidersPrevention Professional
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)