Provider Demographics
NPI:1447501705
Name:LAYNE, TIFFANY LOUDERMILT (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:LOUDERMILT
Last Name:LAYNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 DEERCROFT DR
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-9830
Mailing Address - Country:US
Mailing Address - Phone:704-883-2032
Mailing Address - Fax:
Practice Address - Street 1:542 BROOKDALE DR
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-4108
Practice Address - Country:US
Practice Address - Phone:704-872-4058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0089391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical