Provider Demographics
NPI:1538472113
Name:DILLON, GEORGE JR (CIT)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:DILLON
Suffix:JR
Gender:M
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06120-2508
Mailing Address - Country:US
Mailing Address - Phone:860-808-8789
Mailing Address - Fax:860-808-8771
Practice Address - Street 1:500 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-2508
Practice Address - Country:US
Practice Address - Phone:860-808-8789
Practice Address - Fax:860-808-8771
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCIT-3904101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor