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Individual

STAUTCIA TILLMAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MS, LPC, NCC

Contact information

Practice address
920 GREEN ST SW STE B, CONYERS, GA 30012-5310
(678) 304-8902
Mailing address
PO BOX 81384, CONYERS, GA 30013-9384
(404) 472-6224

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
APC004552
GA
101YM0800X
Mental Health Counselor
Primary
LPC010415
GA

Other

Enumeration date
11/13/2017
Last updated
10/30/2025
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