Provider Demographics
NPI:1003356742
Name:DILLARD, ANTHONY SR (NCRS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:DILLARD
Suffix:SR
Gender:M
Credentials:NCRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-2107
Mailing Address - Country:US
Mailing Address - Phone:708-868-5014
Mailing Address - Fax:708-868-8335
Practice Address - Street 1:995 BODE RD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-4523
Practice Address - Country:US
Practice Address - Phone:224-238-3279
Practice Address - Fax:224-238-3279
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-8723-0002-A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)