Provider Demographics
NPI:1477931640
Name:TILLINGHAST, JORDANNA (MSW, NCAC-I, CAC-II)
Entity Type:Individual
Prefix:
First Name:JORDANNA
Middle Name:
Last Name:TILLINGHAST
Suffix:
Gender:F
Credentials:MSW, NCAC-I, CAC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802B W BUFORD ST
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341
Mailing Address - Country:US
Mailing Address - Phone:864-838-0950
Mailing Address - Fax:
Practice Address - Street 1:187 W BROAD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-3234
Practice Address - Country:US
Practice Address - Phone:864-582-7588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15050111101YA0400X
SC93157101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)