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General NPI Number Information
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NPI Number | 1508411026
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Entity Type | Individual
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Provider Name | TRISTAN WAYNE KILLIAN LCSW, LCAS, CCS
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Gender | Male
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Dates
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Enumeration Date | 08/02/2019
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 3114 E BURMA RD
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City | NEBO
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State | NC
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Zip | 28761-8718
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Country | US
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Telephone | 828-201-6901
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Fax |
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Provider Business Mailing Address
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Address Line | 356 BEAVER CREEK RD
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City | MARION
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State | NC
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Zip | 28752-9081
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Country | US
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Telephone | 828-201-6901
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCAS-25220
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | C015255
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C015255
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | C015255
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C015255
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License Number State | NC
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