Provider Demographics
NPI:1376625509
Name:STILLWELL, LYNNE A (MA, LPC)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:A
Last Name:STILLWELL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2132 AVONCREST DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-2121
Mailing Address - Country:US
Mailing Address - Phone:586-268-6712
Mailing Address - Fax:586-268-6908
Practice Address - Street 1:4151 17 MILE RD STE D
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-6866
Practice Address - Country:US
Practice Address - Phone:586-268-6712
Practice Address - Fax:586-268-6908
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008323101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional