Provider Demographics
NPI:1366566432
Name:TILLMAN, STEVEN R
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:R
Last Name:TILLMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 STAMP ROAD
Mailing Address - Street 2:SUITE # 208
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748
Mailing Address - Country:US
Mailing Address - Phone:301-278-7956
Mailing Address - Fax:301-909-0916
Practice Address - Street 1:4400 STAMP ROAD
Practice Address - Street 2:SUITE # 208
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748
Practice Address - Country:US
Practice Address - Phone:301-278-7956
Practice Address - Fax:301-909-0916
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCACII1073101YA0400X
VA0710102761101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)