| NPI | 1114589991 |
|---|---|
| Former Name | IVY DENISE TILLMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904008045) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2025-06-02 |