Individual
MS. JACQUELINE ANN TILLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, LCADC, NCC
Contact information
Practice address
1 OLD WOLFE RD, SUITE 203, BUDD LAKE, NJ 07828-3213
(862) 432-9783
Mailing address
45 DORSET DR, HACKETTSTOWN, NJ 07840-5010
(862) 258-3231
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
37LC00106500
NJ
101YP2500X
Professional Counselor
37PC00375000
NJ
Other
Enumeration date
03/31/2011
Last updated
03/31/2011
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