Provider Demographics
NPI:1710277942
Name:TILLIE'S HOUSE OF HOPE
Entity Type:Organization
Organization Name:TILLIE'S HOUSE OF HOPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TILLIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MA,NCC,LCPC
Authorized Official - Phone:240-682-4247
Mailing Address - Street 1:10009 PREAKNESS DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-3865
Mailing Address - Country:US
Mailing Address - Phone:240-682-4247
Mailing Address - Fax:
Practice Address - Street 1:10009 PREAKNESS DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3865
Practice Address - Country:US
Practice Address - Phone:240-682-4247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2897251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health