| Doctor Name: | MR. DAVID ROGER TILLIS |
| NPI Number: | 1114159696 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC, NCC, MAC |
| License Number: | MAC030853 |
| Business Practice Address: | 9635 Ventana Way Suite 101 Johns Creek, GA - 300228620 |
| Business Phone Number: | 7704956339 |
| Business Fax Number: | 7704956338 |
| Mailing Address: | 9635 Ventana Way, Suite 101 JOHNS CREEK |
| State: | GA |
| Postal Code: | 300228620 |
| Phone Number: | 7704956339 |
| Fax Number: | 7704956338 |
| NPI Enumeration Date: | 08/17/2009 |
| NPI Last Update Date: | 08/17/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | MAC030853 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |