MEDICARE: DR. FELICIA TILLMAN PHD, LPC, NCC

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
1	101YM0800X	Mental Health Counselor	010817	GA

General Provider Information

NPI Number	:	1609332246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FELICIA TILLMAN PHD, LPC, NCC

Provider Business Mailing Address
First Line	:	PO BOX 1176
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-6176
Country	:	US
Telephone Number	:	931-632-3631
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 MARTIN LUTHER KING JR DR SW # 304
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30303-3536
Country	:	US
Telephone Number	:	931-632-3631
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2019
Last Update Date	:	02/19/2019

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