Individual
TIFFANY DEE PHASUKKAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
2129 S GLENBURNIE RD STE 17, NEW BERN, NC 28562-2240
(252) 341-4192
(866) 309-9297
Mailing address
308 GREENVILLE BLVD SE STE B1, GREENVILLE, NC 27858-5758
(252) 341-4192
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-17-29180
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-17-29180
BEHAVIOR ANALYST CERTIFICATION BOARD
—
Enumeration date
03/26/2018
Last updated
03/26/2018
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