Provider Demographics
NPI:1972984888
Name:TILLMAN, LU EVELYN JACOBS (LCSW, LCASA, TF-CBT)
Entity Type:Individual
Prefix:
First Name:LU EVELYN
Middle Name:JACOBS
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:LCSW, LCASA, TF-CBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 PINE TREE LN
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-2430
Mailing Address - Country:US
Mailing Address - Phone:910-336-3554
Mailing Address - Fax:
Practice Address - Street 1:402 HARRIS AVE
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-3112
Practice Address - Country:US
Practice Address - Phone:910-875-5590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21969101YA0400X
NCC0109371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)