Healthcare Provider Details

I. General information

NPI: 1780079947
Provider Name (Legal Business Name): AARON BERNARD CILWA LMHC, SUDP, CCMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17500 25TH AVE NE UNIT H206
MARYSVILLE WA
98271-4808
US

IV. Provider business mailing address

17500 25TH AVE NE UNIT H206
MARYSVILLE WA
98271-4808
US

V. Phone/Fax

Practice location:
  • Phone: 517-505-0293
  • Fax:
Mailing address:
  • Phone: 517-505-0293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC-02812
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60805563
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401014232
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60694014
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: