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NPI Code Detail

MEDICARE: SARAH KATHERINE TILLER LCSW, LCAS

MEDICARE: SARAH KATHERINE TILLER LCSW, LCAS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerC005810NC
2101YA0400XAddiction (Substance Use Disorder) CounselorLCAS-24439NC

General Provider Information

NPI Number : 1073788220
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH KATHERINE TILLER LCSW, LCAS
Provider Business Mailing Address
First Line : 3216 JOBS JOURNEY CT APT 101
Second Line :
City : RALEIGH
State : NC
Zip : 27610-6655
Country : US
Telephone Number : 919-518-6957
Fax Number :
Provider Business Practice Location Address
First Line : 5509 CREEDMOOR RD
Second Line :
City : RALEIGH
State : NC
Zip : 27612-6312
Country : US
Telephone Number : 919-573-6531
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2008
Last Update Date : 10/14/2020

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