Provider Demographics
NPI:1558439992
Name:TILLMAN, VICKI DUNCAN (MA)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:DUNCAN
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 POLLY DRUMMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-5703
Mailing Address - Country:US
Mailing Address - Phone:302-738-6859
Mailing Address - Fax:302-368-5309
Practice Address - Street 1:8 POLLY DRUMMOND HILL RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-5703
Practice Address - Country:US
Practice Address - Phone:302-738-6859
Practice Address - Fax:302-368-5309
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000269101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE2264422Medicare UPIN
DE159626Medicare UPIN
DE2125118Medicare UPIN
DE62-34240Medicare UPIN
DE51-0035LPCMedicare UPIN