Provider Demographics
NPI:1255098430
Name:TILLOTSON, DREW CARTER
Entity type:Individual
Prefix:DR
First Name:DREW
Middle Name:CARTER
Last Name:TILLOTSON
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DREW
Other - Middle Name:CARTER
Other - Last Name:TILLOTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1315 PLYMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-1240
Mailing Address - Country:US
Mailing Address - Phone:415-845-8538
Mailing Address - Fax:
Practice Address - Street 1:1730 DIVISADERO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3012
Practice Address - Country:US
Practice Address - Phone:415-551-7970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16651103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist