Provider Demographics
NPI:1144573585
Name:DILLON, LEAH JOSEPHINE (MA)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:JOSEPHINE
Last Name:DILLON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 WEST 226TH STREET
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2074
Mailing Address - Country:US
Mailing Address - Phone:310-373-4556
Mailing Address - Fax:
Practice Address - Street 1:4025 W 226TH ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2340
Practice Address - Country:US
Practice Address - Phone:310-373-4556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90510101YM0800X
CA112430106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health