Provider Demographics
NPI:1245605187
Name:TILLMAN, BRITTANY J
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:J
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 OLD BUCKHORN RD
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-3770
Mailing Address - Country:US
Mailing Address - Phone:910-650-9603
Mailing Address - Fax:
Practice Address - Street 1:103 FOUNTAIN BROOK CIRCLE
Practice Address - Street 2:SUITE D-3
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511
Practice Address - Country:US
Practice Address - Phone:919-694-7128
Practice Address - Fax:919-234-5117
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-03
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10061A106H00000X
NC1818106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist