Individual
TIFFANY SHANTE' SAMUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
444 2ND LOOP RD, FLORENCE, SC 29505-2814
(843) 536-9674
Mailing address
1321 MURFREESBORO PIKE STE 702, NASHVILLE, TN 37217-2679
(615) 361-4000
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-19-95158
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000000
—
VA
Enumeration date
01/10/2021
Last updated
05/16/2022
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