Provider Demographics
NPI:1811248099
Name:TILLEY, JANE ALLEN (LCAS, LPC)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:ALLEN
Last Name:TILLEY
Suffix:
Gender:F
Credentials:LCAS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 TURNER DR
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-5736
Mailing Address - Country:US
Mailing Address - Phone:336-349-2233
Mailing Address - Fax:
Practice Address - Street 1:229 TURNER DR
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-5736
Practice Address - Country:US
Practice Address - Phone:336-349-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2575101YA0400X
NC9584101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)