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General NPI Number Information
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NPI Number | 1184830275
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Entity Type | Individual
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Provider Name | JEROME EDWARD TILGHMAN JR. LPC, CAC II
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Gender | Male
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 03/03/2019
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Provider Practice Location Address
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Address Line | 117 E MAIN ST
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City | MONCKS CORNER
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State | SC
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Zip | 29461-3764
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Country | US
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Telephone | 843-312-3319
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Fax | 800-948-6030
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Provider Business Mailing Address
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Address Line | PO BOX 474
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City | MONCKS CORNER
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State | SC
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Zip | 29461-0474
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Country | US
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Telephone | 843-364-2321
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Fax | 800-948-6030
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 5
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3396
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License Number State | SC
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