Provider Demographics
NPI:1710675764
Name:DILLARD, MARIA (RMHCI)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:DILLARD
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:LANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1882 BAYOU DR
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-7600
Mailing Address - Country:US
Mailing Address - Phone:719-629-6218
Mailing Address - Fax:
Practice Address - Street 1:9466 NAVARRE PKWY STE B
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-2948
Practice Address - Country:US
Practice Address - Phone:194-580-7947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH23539101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health