Provider Demographics
NPI:1063678423
Name:DILLMAN, KERRY ANNE (MA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:ANNE
Last Name:DILLMAN
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3414 FLINT HILL PL
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-1011
Mailing Address - Country:US
Mailing Address - Phone:703-491-0380
Mailing Address - Fax:
Practice Address - Street 1:3414 FLINT HILL PL
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-1011
Practice Address - Country:US
Practice Address - Phone:703-491-0380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health