Healthcare Provider Details

I. General information

NPI: 1629246053
Provider Name (Legal Business Name): LARRY HOWARD DILLARD II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11417 D AVE
AUBURN CA
95603-2708
US

IV. Provider business mailing address

11417 D AVE
AUBURN CA
95603-2708
US

V. Phone/Fax

Practice location:
  • Phone: 530-885-1917
  • Fax: 530-885-1169
Mailing address:
  • Phone: 530-885-1917
  • Fax: 530-885-1169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: