Healthcare Provider Details

I. General information

NPI: 1215701677
Provider Name (Legal Business Name): MITCHELL W DILLON MS, CGC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1052 LAKEFRONT WOODS DR
BELMONT NC
28012-8694
US

IV. Provider business mailing address

1052 LAKEFRONT WOODS DR
BELMONT NC
28012-8694
US

V. Phone/Fax

Practice location:
  • Phone: 917-426-4178
  • Fax:
Mailing address:
  • Phone: 917-426-4178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number25MJ00026000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC676
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC.000096
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: