Provider Demographics
NPI:1659935195
Name:DILLON, CAROL JANE (LPC PROFESSIONAL LIC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:JANE
Last Name:DILLON
Suffix:
Gender:F
Credentials:LPC PROFESSIONAL LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 NORTH 7TH AVENUE
Mailing Address - Street 2:SUITE D
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201
Mailing Address - Country:US
Mailing Address - Phone:208-242-3044
Mailing Address - Fax:208-904-0494
Practice Address - Street 1:707 NORTH 7TH AVENUE
Practice Address - Street 2:SUITE D
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201
Practice Address - Country:US
Practice Address - Phone:208-242-3044
Practice Address - Fax:208-904-0494
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCP-292101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health