Provider Demographics
NPI:1831334606
Name:STILLWAGON, MICHELLE CELINA (LLPC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CELINA
Last Name:STILLWAGON
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 W REMUS RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-9076
Mailing Address - Country:US
Mailing Address - Phone:989-506-4410
Mailing Address - Fax:
Practice Address - Street 1:568 W REMUS RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-9076
Practice Address - Country:US
Practice Address - Phone:989-506-4410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1412271101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor