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General NPI Number Information
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NPI Number | 1710335575
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Entity Type | Individual
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Provider Name | NICOLE TILTON LPC
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Gender | Female
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Dates
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Enumeration Date | 06/01/2016
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Last Update Date | 11/22/2023
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Provider Practice Location Address
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Address Line | 616 WASHINGTON ST STE 2A
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City | TOMS RIVER
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State | NJ
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Zip | 08753-6789
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Country | US
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Telephone | 609-594-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 730 HERBERTSVILLE RD
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City | BRICK
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State | NJ
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Zip | 08724-1109
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Country | US
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Telephone | 732-378-9337
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 37PC00512100
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License Number State | NJ
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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 | 37PC00512100
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License Number State | NJ
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