Active NPI
Tiffany Shante' Samuel
- Behavior Technician
- Florence, SC
National Provider Identifier
1093303513
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-19-95158
- Practice address
- 444 2ND Loop Rd
Florence, SC 29505-2814 - Phone
- (843) 536-9674
- NPI assigned
- Jan 10, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-19-95158 | VA | Primary |
Addresses
Primary practice location
444 2ND Loop Rd
Florence, SC 29505-2814
Mailing address
1321 Murfreesboro Pike Ste 702
Nashville, TN 37217-2679
Phone (615) 361-4000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0000000 | Medicaid | VA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Henrico | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-19-95158 | VA | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Civitas Health Services, Inc. | Current | Accepting new patients |
Locations
5663 S Laburnum Ave
Richmond, VA 23231
Phone (804) 737-3917
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community/Behavioral Health Agency
- Richmond, VA
- NPI 1366727984
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652659200000",
"number": "1093303513",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1321 MURFREESBORO PIKE STE 702",
"city": "NASHVILLE",
"state": "TN",
"postal_code": "372172679",
"telephone_number": "615-361-4000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "444 2ND LOOP RD",
"city": "FLORENCE",
"state": "SC",
"postal_code": "295052814",
"telephone_number": "843-536-9674"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMUEL",
"first_name": "TIFFANY",
"middle_name": "SHANTE'",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-01-10",
"last_updated": "2022-05-16",
"certification_date": "2022-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "VA",
"license": "RBT-19-95158",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0000000",
"state": "VA"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Henrico",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "5663 S Laburnum Ave",
"city": "Henrico",
"state": "VA",
"country_code": "US",
"postal_code": "232314418",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Florence, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.