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Individual
MR. RICARDO DAVID TILLERY
Active
Individual
MR. RICARDO DAVID TILLERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MBA, LMSW, ICAADC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
C-02622
MI
103K00000X
Behavior Analyst
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
6801094835
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396128088
—
MI
Enumeration date
02/17/2010
Last updated
09/13/2020
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