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General NPI Number Information
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NPI Number | 1598891640
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Entity Type | Individual
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Provider Name | JAMES CLIFFTON TILLERY LPC, MAC, NCC
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Gender | Male
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Dates
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Enumeration Date | 02/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3936 HOLCOMB BRIDGE RD
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City | NORCROSS
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State | GA
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Zip | 30092-2206
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Country | US
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Telephone | 404-405-6838
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Fax |
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Provider Business Mailing Address
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Address Line | 4520 TIMBER PATH CT SW
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City | LILBURN
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State | GA
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Zip | 30047-8900
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Country | US
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Telephone | 770-806-8556
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 002379
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License Number State | GA
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