Provider Demographics
NPI:1942590195
Name:DILLINGER, MARIE E (LMHC)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:E
Last Name:DILLINGER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 RIVERS EDGE CT
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-2418
Mailing Address - Country:US
Mailing Address - Phone:727-643-4340
Mailing Address - Fax:866-266-6555
Practice Address - Street 1:2115 RIVERS EDGE CT
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-2418
Practice Address - Country:US
Practice Address - Phone:727-643-4340
Practice Address - Fax:866-266-6555
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10875101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
12275129OtherCAQH