Individual
MS. BEVERLY DIANE TILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAADC-CA LCI2361214
Contact information
Practice address
101 GOUGH ST, SAN FRANCISCO, CA 94102
(415) 553-3252
Mailing address
101 GOUGH ST, SAN FRANCISCO, CA 94102-5903
(415) 553-3252
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCI2361214
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03-068218
CAARR
CA
Enumeration date
05/30/2007
Last updated
06/12/2018
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