Provider Demographics
NPI:1568931202
Name:STILLWELL, DANIEL H (PHD, LMFT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:H
Last Name:STILLWELL
Suffix:
Gender:M
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 E WOODLAWN RD APT C
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-2241
Mailing Address - Country:US
Mailing Address - Phone:859-509-7088
Mailing Address - Fax:
Practice Address - Street 1:1515 MOCKINGBIRD LN STE 540
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3297
Practice Address - Country:US
Practice Address - Phone:980-552-0083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-23
Last Update Date:2018-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1788106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist