Provider Demographics
NPI:1790831907
Name:DILLON-STOUT, DONNA (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:
Last Name:DILLON-STOUT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 REA FOREST DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3191
Mailing Address - Country:US
Mailing Address - Phone:704-543-6403
Mailing Address - Fax:704-442-8103
Practice Address - Street 1:309 S SHARON AMITY RD
Practice Address - Street 2:SUITE 302
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2978
Practice Address - Country:US
Practice Address - Phone:704-442-0083
Practice Address - Fax:704-442-8103
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2315103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical