Provider Demographics
NPI:1720351471
Name:WELLIVER, DILLON GARRETT (LMHC, CAP)
Entity Type:Individual
Prefix:
First Name:DILLON
Middle Name:GARRETT
Last Name:WELLIVER
Suffix:
Gender:M
Credentials:LMHC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 S PENINSULA DR SIDE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32118-5910
Mailing Address - Country:US
Mailing Address - Phone:386-316-6197
Mailing Address - Fax:
Practice Address - Street 1:2902 S PENINSULA DR SIDE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32118-5910
Practice Address - Country:US
Practice Address - Phone:386-316-6197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9586101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health