Provider Demographics
NPI:1457502379
Name:DILLMAN, LISA MARIE (MA, QMHP, CADC I)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:DILLMAN
Suffix:
Gender:F
Credentials:MA, QMHP, CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 NE KIRBY ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-4301
Mailing Address - Country:US
Mailing Address - Phone:781-510-1376
Mailing Address - Fax:
Practice Address - Street 1:340 NE KIRBY ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4301
Practice Address - Country:US
Practice Address - Phone:781-510-1376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health