Provider Demographics
NPI:1952400996
Name:DILLON, DEBRA SUE (MA RN C)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:SUE
Last Name:DILLON
Suffix:
Gender:F
Credentials:MA RN C
Other - Prefix:MS
Other - First Name:DEBRA
Other - Middle Name:S
Other - Last Name:DILLON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA RN C
Mailing Address - Street 1:3810 WINCHESTER RD
Mailing Address - Street 2:SOUTHEAST MENTAL HEALTH CENTER
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-9007
Mailing Address - Country:US
Mailing Address - Phone:901-312-7518
Mailing Address - Fax:901-369-1452
Practice Address - Street 1:3810 WINCHESTER RD
Practice Address - Street 2:SOUTHEAST MENTAL HEALTH CENTER
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-9007
Practice Address - Country:US
Practice Address - Phone:901-369-1420
Practice Address - Fax:901-369-1433
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000103348163W00000X, 163WA0400X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)