Individual
TERRANCE TILLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1100 KENNEBEC ST APT 4D, OXON HILL, MD 20745-3308
(202) 880-4987
Mailing address
1100 KENNEBEC ST APT 4D, OXON HILL, MD 20745-3308
(202) 880-4987
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/04/2023
Last updated
04/04/2023
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