Healthcare Provider Details

I. General information

NPI: 1790754166
Provider Name (Legal Business Name): TAMMY J STILLION MA, PCC-S, LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44020 MARIETTA RD
CALDWELL OH
43724-9124
US

IV. Provider business mailing address

2845 BELL ST
ZANESVILLE OH
43701-1720
US

V. Phone/Fax

Practice location:
  • Phone: 740-732-5233
  • Fax: 740-732-4777
Mailing address:
  • Phone: 740-454-9766
  • Fax: 740-588-6452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.161637
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE3825
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: