Provider Demographics
NPI:1730562877
Name:TIFFANY HOUCK-LOOMIS
Entity type:Organization
Organization Name:TIFFANY HOUCK-LOOMIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUCK-LOOMIS
Authorized Official - Suffix:
Authorized Official - Credentials:MDIV, PHD, FBPPC
Authorized Official - Phone:917-232-7232
Mailing Address - Street 1:2109 WOODROW ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3229
Mailing Address - Country:US
Mailing Address - Phone:917-232-7232
Mailing Address - Fax:
Practice Address - Street 1:2109 WOODROW ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3229
Practice Address - Country:US
Practice Address - Phone:917-232-7232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC105101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty