Healthcare Provider Details

I. General information

NPI: 1396337358
Provider Name (Legal Business Name): PRESTON DILLON MANNON MA, LPCC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 E MEMORIAL DR
POMEROY OH
45769-9569
US

IV. Provider business mailing address

PO BOX 188
CHILLICOTHEE OH
45601-0188
US

V. Phone/Fax

Practice location:
  • Phone: 740-992-2192
  • Fax: 740-992-4018
Mailing address:
  • Phone: 740-773-4366
  • Fax: 740-773-4750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2303822
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: