Provider Demographics
NPI:1770813883
Name:TILLMAN, JAMES EDWARD JR (CADC II)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EDWARD
Last Name:TILLMAN
Suffix:JR
Gender:M
Credentials:CADC II
Other - Prefix:
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Mailing Address - Street 1:730 SUNRISE AVE
Mailing Address - Street 2:SUITE #250
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4567
Mailing Address - Country:US
Mailing Address - Phone:530-787-4357
Mailing Address - Fax:
Practice Address - Street 1:730 SUNRISE AVE
Practice Address - Street 2:SUITE #250
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4567
Practice Address - Country:US
Practice Address - Phone:530-787-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA4001007101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)