Provider Demographics
NPI:1184830275
Name:TILGHMAN, JEROME EDWARD JR (LPC, CAC II)
Entity Type:Individual
Prefix:MR
First Name:JEROME
Middle Name:EDWARD
Last Name:TILGHMAN
Suffix:JR
Gender:M
Credentials:LPC, CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 474
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-0474
Mailing Address - Country:US
Mailing Address - Phone:843-364-2321
Mailing Address - Fax:800-948-6030
Practice Address - Street 1:117 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3764
Practice Address - Country:US
Practice Address - Phone:843-312-3319
Practice Address - Fax:800-948-6030
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2019-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5101YA0400X
SC3396101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)