Provider Demographics
NPI:1710465497
Name:DILLARD, MARSHA A (MA, LPC INTERN)
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:A
Last Name:DILLARD
Suffix:
Gender:F
Credentials:MA, LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 N SAM HOUSTON PKWY E APT 1306
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-4601
Mailing Address - Country:US
Mailing Address - Phone:832-343-5779
Mailing Address - Fax:
Practice Address - Street 1:7324 SOUTHWEST FWY STE 1484
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2175
Practice Address - Country:US
Practice Address - Phone:713-352-8358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80104101YM0800X, 101YP2500X
TX40401225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor