Provider Demographics
NPI:1952742124
Name:TILLEMANS, REBECCA (MS LCPC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:TILLEMANS
Suffix:
Gender:F
Credentials:MS LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10801 HICKORY RIDGE RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3869
Mailing Address - Country:US
Mailing Address - Phone:410-456-3549
Mailing Address - Fax:
Practice Address - Street 1:10801 HICKORY RIDGE RD
Practice Address - Street 2:SUITE 220
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3869
Practice Address - Country:US
Practice Address - Phone:410-456-3549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4139101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health