Provider Demographics
NPI:1528087491
Name:TODD-PILLMAN, BRAD MICHAEL (PHD)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:MICHAEL
Last Name:TODD-PILLMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 MEDICAL PARK LOOP
Mailing Address - Street 2:SUITE 502
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-5222
Mailing Address - Country:US
Mailing Address - Phone:828-586-5555
Mailing Address - Fax:828-586-5527
Practice Address - Street 1:186 MEDICAL PARK LOOP
Practice Address - Street 2:SUITE 502
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5222
Practice Address - Country:US
Practice Address - Phone:828-586-5555
Practice Address - Fax:828-586-5527
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3023103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000674Medicaid
NC046HROtherBCBS NC
NC046HROtherBCBS NC