Loretta I. Tillman, MA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

3411 Issued in NC

Practice address

5736 N Tryon St Ste 200
Charlotte, NC 28213-0820

Phone

(704) 921-6777

Fax

(704) 509-2220

NPI assigned

Jan 23, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor of Arts, Master of Arts

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  NC

  Medicare reassignment NPD
• Innovative Community Resources NC Inc

  • Mental Health Counselor
  • Charlotte, NC
  • NPI 1326249434
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356495402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5736 N TRYON ST STE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282130820",
            "telephone_number": "704-921-6777",
            "fax_number": "704-509-2220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5736 N TRYON ST STE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282130820",
            "telephone_number": "704-921-6777",
            "fax_number": "704-509-2220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLMAN",
        "first_name": "LORETTA",
        "middle_name": "I.",
        "name_prefix": "Mrs.",
        "credential": "MA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "3411",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6102097",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Colton R Tilley, DDS
• George Edward Tilley, LCSW
• India D Tilley, PTA
• Brittany Tillman
• Kayla Tillman
• Rita Tillman, LCSWA
• Robert Harrison Tillman, MD
• Stephanie Tillman
• Zycoria Makayla Tillman, LCSWA
• Cheryl A Tillson, CRNA

• Mental Health Counselor in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.