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Individual

DESONTA TILLMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2930 S MICHIGAN AVE STE 100, CHICAGO, IL 60616-3484
(773) 819-5504
Mailing address
1233 E 70TH ST, CHICAGO, IL 60637-4708
(773) 793-4155

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
101YM0800X
IL
Enumeration date
02/07/2019
Last updated
02/07/2019
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