Provider Demographics
NPI:1821536020
Name:STILLION, KERI (LSW, LCDC-III)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:STILLION
Suffix:
Gender:F
Credentials:LSW, LCDC-III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 STOVER DR
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-8601
Mailing Address - Country:US
Mailing Address - Phone:740-369-6811
Mailing Address - Fax:
Practice Address - Street 1:118 STOVER DR
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-8601
Practice Address - Country:US
Practice Address - Phone:740-369-6811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH001410101YA0400X
OHS.0500676101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health