Provider Demographics
NPI:1528612876
Name:TILLIT, JAMIE EILEEN (LPC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:EILEEN
Last Name:TILLIT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 OSIGIAN BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8925
Mailing Address - Country:US
Mailing Address - Phone:478-449-1475
Mailing Address - Fax:877-712-4794
Practice Address - Street 1:109 OSIGIAN BLVD STE 400
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8925
Practice Address - Country:US
Practice Address - Phone:478-449-1475
Practice Address - Fax:877-712-4794
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004039101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional