Provider Demographics
NPI:1558938886
Name:DILLON, IMANI
Entity Type:Individual
Prefix:
First Name:IMANI
Middle Name:
Last Name:DILLON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:IMANI
Other - Middle Name:
Other - Last Name:DILLON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IMANI DILLON
Mailing Address - Street 1:104 OAKCHEST CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-9615
Mailing Address - Country:US
Mailing Address - Phone:919-957-2940
Mailing Address - Fax:
Practice Address - Street 1:104 OAKCHEST CT
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-9615
Practice Address - Country:US
Practice Address - Phone:919-957-2940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist