| Doctor Name: | MILDRED BENNETT TILLMAN |
| NPI Number: | 1467898221 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPCA |
| License Number: | A10076 |
| Business Practice Address: | 11205 Lawyers Rd Ste F Mint Hill, NC - 282279333 |
| Business Phone Number: | 9802265590 |
| Business Fax Number: | 9802265580 |
| Mailing Address: | 3921 Caliper Pl, FORT MILL |
| State: | SC |
| Postal Code: | 297088380 |
| Phone Number: | 8033709253 |
| Fax Number: | |
| NPI Enumeration Date: | 05/20/2013 |
| NPI Last Update Date: | 05/20/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | A10076 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |