Provider Demographics
NPI:1720723638
Name:DILLARD, EBONYE R (LADAC II)
Entity Type:Individual
Prefix:
First Name:EBONYE
Middle Name:R
Last Name:DILLARD
Suffix:
Gender:F
Credentials:LADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22065
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37202-2065
Mailing Address - Country:US
Mailing Address - Phone:615-434-8195
Mailing Address - Fax:
Practice Address - Street 1:4065 CANE RIDGE PKWY APT 227
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-4742
Practice Address - Country:US
Practice Address - Phone:615-609-1652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1271101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)