Provider Demographics
NPI:1538630405
Name:TILBERRY, BRITTANY JEANNE
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:JEANNE
Last Name:TILBERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 DANDELION LN
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-4126
Mailing Address - Country:US
Mailing Address - Phone:843-504-9972
Mailing Address - Fax:
Practice Address - Street 1:4325 DICK POND RD
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-6810
Practice Address - Country:US
Practice Address - Phone:843-504-9972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6659101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional