Provider Demographics
NPI:1053941120
Name:BROWN STILTNER, CYNTHIA (NCC, LCAS-A, LCMHCA)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:BROWN STILTNER
Suffix:
Gender:F
Credentials:NCC, LCAS-A, LCMHCA
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:
Other - Last Name:BROWN STILTNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NCC, LCAS-A, LPC-A
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:
Mailing Address - City:PINNACLE
Mailing Address - State:NC
Mailing Address - Zip Code:27043-0486
Mailing Address - Country:US
Mailing Address - Phone:336-624-5788
Mailing Address - Fax:
Practice Address - Street 1:320 E LEE AVE
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-8132
Practice Address - Country:US
Practice Address - Phone:336-679-8805
Practice Address - Fax:336-679-3057
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-20833101YA0400X
NCA15107101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC016A3OtherDAYMARK GROUP BCBSNC PPN
NC1053941120Medicaid
NC1558329243Medicaid