Provider Demographics
NPI:1811233919
Name:DILLINGHAM, CHI-ELLA MARIE
Entity Type:Individual
Prefix:
First Name:CHI-ELLA
Middle Name:MARIE
Last Name:DILLINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 FELIX PL APT 230
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4678
Mailing Address - Country:US
Mailing Address - Phone:405-822-2031
Mailing Address - Fax:
Practice Address - Street 1:7901 NE 10TH ST
Practice Address - Street 2:B106
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-3600
Practice Address - Country:US
Practice Address - Phone:405-736-0056
Practice Address - Fax:405-736-0057
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health