Jacqueline Ann Tillson, LPC, LCADC, NCC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

37LC00106500 Issued in NJ

Practice address

1 Old Wolfe Rd
Suite 203
Budd Lake, NJ 07828-3213

Phone

(862) 432-9783

NPI assigned

Mar 31, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1301529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301529600000",
    "number": "1992094890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 DORSET DR",
            "city": "HACKETTSTOWN",
            "state": "NJ",
            "postal_code": "078405010",
            "telephone_number": "862-258-3231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 OLD WOLFE RD",
            "address_2": "SUITE 203",
            "city": "BUDD LAKE",
            "state": "NJ",
            "postal_code": "078283213",
            "telephone_number": "862-432-9783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLSON",
        "first_name": "JACQUELINE",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "LPC, LCADC, NCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-03-31",
        "last_updated": "2011-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NJ",
            "license": "37LC00106500",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NJ",
            "license": "37PC00375000",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Medical Center at Budd Lake
• The Rose House
• The Rose House
• Amanda Marie Thompson
• Hailey Thompson
• Nicole Vales
• Litza Vallejo
• John V. Vecchione, D.D.S
• Vedikh Dynamic Rehab LLC
• Pauline B. Verona

• Addiction (Substance Use Disorder) Counselor in Budd Lake, NJ
• Providers in Budd Lake, NJ by specialty
• Addiction (Substance Use Disorder) Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.