Provider Demographics
NPI:1578536918
Name:TILSON, LINDA CHARLENE (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:CHARLENE
Last Name:TILSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 COMMERCIAL COURT
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406
Mailing Address - Country:US
Mailing Address - Phone:912-303-0420
Mailing Address - Fax:912-303-0283
Practice Address - Street 1:500 COMMERCIAL COURT
Practice Address - Street 2:SUITE 3
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406
Practice Address - Country:US
Practice Address - Phone:912-303-0420
Practice Address - Fax:912-303-0283
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASW0026781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBDZJMedicare ID - Type Unspecified
GAS84537Medicare UPIN