Provider Demographics
NPI:1568130557
Name:DILLARD, CHRISTINA (EDD, LEP3529)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:
Last Name:DILLARD
Suffix:
Gender:F
Credentials:EDD, LEP3529
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 BEECH AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-3117
Mailing Address - Country:US
Mailing Address - Phone:213-247-7005
Mailing Address - Fax:
Practice Address - Street 1:1609 BEECH AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-3117
Practice Address - Country:US
Practice Address - Phone:213-247-7005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LEP3529103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool