Provider Demographics
NPI:1063886737
Name:TILLMAN, ANGELA (MS CADCII)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:MS CADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3985 ARKWRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1774
Mailing Address - Country:US
Mailing Address - Phone:478-477-2070
Mailing Address - Fax:
Practice Address - Street 1:3985 ARKWRIGHT RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1774
Practice Address - Country:US
Practice Address - Phone:478-477-2070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA452101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)