Healthcare Provider Details

I. General information

NPI: 1679198840
Provider Name (Legal Business Name): CHAD STILTNER CDCA.181056
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 GRANT ST
PORTSMOUTH OH
45662-3663
US

IV. Provider business mailing address

411 COURT ST
PORTSMOUTH OH
45662-3932
US

V. Phone/Fax

Practice location:
  • Phone: 740-901-0416
  • Fax:
Mailing address:
  • Phone: 740-354-6685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.176495
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.181056
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: