Provider Demographics
NPI:1740585041
Name:TILLMAN, CAROLE L (MS, LAADC-CA)
Entity Type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:L
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:MS, LAADC-CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3637 MISSION AVE BLDG B
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-2946
Mailing Address - Country:US
Mailing Address - Phone:916-485-4175
Mailing Address - Fax:916-480-2241
Practice Address - Street 1:3637 MISSION AVE BLDG B
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608
Practice Address - Country:US
Practice Address - Phone:916-485-4175
Practice Address - Fax:916-480-2241
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor