Provider Demographics
NPI:1164226569
Name:TILLERY, VIRGINIA (NCC)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:TILLERY
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 SCOTT TOWN CTR # 1012
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-2356
Mailing Address - Country:US
Mailing Address - Phone:814-317-6576
Mailing Address - Fax:
Practice Address - Street 1:1005 SCOTT TOWN CTR # 1012
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-2356
Practice Address - Country:US
Practice Address - Phone:814-317-6576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health