Provider Demographics
NPI:1710435516
Name:HERNANDEZ, KAREN DILLON (MA, LCAS, LCMHCA, NC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:DILLON
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MA, LCAS, LCMHCA, NC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 WINDY HILL DR NW
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-9095
Mailing Address - Country:US
Mailing Address - Phone:286-101-5678
Mailing Address - Fax:
Practice Address - Street 1:811 CONOVER BLVD W
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-2861
Practice Address - Country:US
Practice Address - Phone:828-610-1567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15775101YP2500X
NC22569101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1710435516Medicaid