Provider Demographics
NPI:1568086528
Name:WILLIAMS-TILLERY, PAULETTE (PHD)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:
Last Name:WILLIAMS-TILLERY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 ESSEX RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4617
Mailing Address - Country:US
Mailing Address - Phone:443-204-7144
Mailing Address - Fax:
Practice Address - Street 1:715 INGLESIDE AVE
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-1726
Practice Address - Country:US
Practice Address - Phone:410-960-2496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health