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General NPI Number Information
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NPI Number | 1477762482
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Entity Type | Individual
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Provider Name | MR. DOUGLAS WEBSTER TILLEY
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Gender | Male
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3954 MURPHY CANYON RD STE D202
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City | SAN DIEGO
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State | CA
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Zip | 92123-4420
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Country | US
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Telephone | 858-505-8031
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Fax |
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Provider Business Mailing Address
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Address Line | 9648 MARILLA DR APT 89
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City | LAKESIDE
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State | CA
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Zip | 92040-2835
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Country | US
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Telephone | 619-312-0540
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Fax |
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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 | RW1098
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License Number State | CA
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