Provider Demographics
NPI:1710212824
Name:DILLON, MISTY (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:DILLON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040B WINDSOR CT
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-5555
Mailing Address - Country:US
Mailing Address - Phone:574-514-7956
Mailing Address - Fax:574-206-8071
Practice Address - Street 1:3040B WINDSOR CT
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-5555
Practice Address - Country:US
Practice Address - Phone:574-514-7956
Practice Address - Fax:574-206-8071
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical