Individual
MR. DAVID ROGER TILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC, NCC, MAC
Contact information
Practice address
9635 VENTANA WAY, SUITE 101, JOHNS CREEK, GA 30022-8620
(770) 495-6339
(770) 495-6338
Mailing address
9635 VENTANA WAY, SUITE 101, JOHNS CREEK, GA 30022-8620
(770) 495-6339
(770) 495-6338
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
MAC030853
GA
101YP2500X
Professional Counselor
Primary
LPC001626
GA
Other
Enumeration date
08/17/2009
Last updated
08/17/2009
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