MR. DAVID ROGER TILLIS LPC NCC MAC NPI 1114159696

NPI Information

  • NPI: 1114159696
  • Provider Name: MR. DAVID ROGER TILLIS, LPC, NCC, MAC
  • Classification: Counselor - 101YP2500X
  • Specialization: Professional
  • Entity Type: Individual
  • Address: 9635 VENTANA WAY
    SUITE 101
    JOHNS CREEK, GA
    ZIP 30022
  • Phone: (770) 495-6339

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NPI Details

MR. David Roger Tillis, LPC, NCC, MAC is a professional counselor in Johns Creek, GA. MR. David Roger Tillis, LPC, NCC, MAC NPI is 1114159696. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

9635 VENTANA WAY
SUITE 101
JOHNS CREEK, GA
ZIP 30022-620
Phone: (770) 495-6339
Fax: (770) 495-6338

The enumeration date for this NPI number is 8/17/2009 and was last updated on 8/17/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1101YA0400XCounselorAddiction (Substance Use Disorder)MAC030853GEORGIANo
2101YP2500XCounselorProfessionalLPC001626GEORGIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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