Provider Demographics
NPI:1801851464
Name:DILLON, MARNIE SMITH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARNIE
Middle Name:SMITH
Last Name:DILLON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4146 CARMICHAEL COURT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106
Mailing Address - Country:US
Mailing Address - Phone:334-409-0210
Mailing Address - Fax:334-409-0250
Practice Address - Street 1:300 TWINING ST BLDG 760
Practice Address - Street 2:
Practice Address - City:MAXWELL AFB
Practice Address - State:AL
Practice Address - Zip Code:36112-6027
Practice Address - Country:US
Practice Address - Phone:334-953-5200
Practice Address - Fax:334-953-8607
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL954103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL05155825Medicaid
710954994OtherTRICARE
283901OtherMHN
344168000OtherMAGELLAN
620006996OtherRR MEDICARE
051510276OtherFED BCBS
AL051001486OtherBCBS-AL
493012OtherVALUE OPTIONS
051555825Medicare ID - Type UnspecifiedMEDICARE