Healthcare Provider Details

I. General information

NPI: 1780136416
Provider Name (Legal Business Name): DEADRA TILLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2016
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 CATHY LN
BURLINGTON NJ
08016-9727
US

IV. Provider business mailing address

6 CATHY LANE
FLORENCE NJ
08518
US

V. Phone/Fax

Practice location:
  • Phone: 609-499-0165
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: