Provider Demographics
NPI:1609332246
Name:TILLMAN, FELICIA (PHD, LPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:FELICIA
Middle Name:
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:PHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1176
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-6176
Mailing Address - Country:US
Mailing Address - Phone:931-632-3631
Mailing Address - Fax:
Practice Address - Street 1:115 MARTIN LUTHER KING JR DR SW # 304
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3536
Practice Address - Country:US
Practice Address - Phone:931-632-3631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010817101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health