Provider Demographics
NPI:1376086827
Name:SMITH, MICHELLE DILLON (LPC, RPT-S, NCC, ACS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DILLON
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC, RPT-S, NCC, ACS
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:DILLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:859 MADDOX RD
Mailing Address - Street 2:
Mailing Address - City:GLADYS
Mailing Address - State:VA
Mailing Address - Zip Code:24554-2427
Mailing Address - Country:US
Mailing Address - Phone:757-880-7123
Mailing Address - Fax:
Practice Address - Street 1:110 VISTA CENTRE DR STE 18
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-2775
Practice Address - Country:US
Practice Address - Phone:434-316-6023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2023-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006225101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health