Individual
AUDRA CAMILLE STILLIONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
108 W MEDIUM MEADOW DR, LYTLE, TX 78052-3985
(678) 603-0001
Mailing address
108 W MEDIUM MEADOW DR, LYTLE, TX 78052-3985
(678) 603-0001
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
60994586
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60994586
STATE
WA
Enumeration date
06/15/2022
Last updated
06/15/2022
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