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NPI Code Detail

MEDICARE: CHARLES DILLARD RBT

MEDICARE: CHARLES DILLARD RBT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1598449001
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES DILLARD RBT
Provider Business Mailing Address
First Line : 708 MOUNT CROSS RD STE A
Second Line :
City : DANVILLE
State : VA
Zip : 24540-5904
Country : US
Telephone Number : 434-228-7603
Fax Number :
Provider Business Practice Location Address
First Line : 708 MOUNT CROSS RD STE A
Second Line :
City : DANVILLE
State : VA
Zip : 24540-5904
Country : US
Telephone Number : 434-228-7603
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2023
Last Update Date : 06/14/2023

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