Provider Demographics
NPI:1790754166
Name:STILLION, TAMMY J (MA, PCC-S, LICDC)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:J
Last Name:STILLION
Suffix:
Gender:F
Credentials:MA, PCC-S, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 BELL ST
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1720
Mailing Address - Country:US
Mailing Address - Phone:740-454-9766
Mailing Address - Fax:740-588-6452
Practice Address - Street 1:44020 MARIETTA RD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:OH
Practice Address - Zip Code:43724-9124
Practice Address - Country:US
Practice Address - Phone:740-732-5233
Practice Address - Fax:740-732-4777
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.161637101YA0400X
OHE3825101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH307825OtherTRICARE/MHN PIN
OH0180823Medicaid
OH543524000OtherMAGELLAN PIN
OHY03725OtherTHE HEALTH PLAN PIN
OH000000344102OtherANTHEM PIN
OH7066609OtherAETNA PIN
OH377001OtherMOUNT CARMEL PIN