Healthcare Provider Details

I. General information

NPI: 1427969815
Provider Name (Legal Business Name): DILLON FULLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

378 W CHESTNUT ST STE 205
WASHINGTON PA
15301-4661
US

IV. Provider business mailing address

378 W CHESTNUT ST STE 205
WASHINGTON PA
15301-4661
US

V. Phone/Fax

Practice location:
  • Phone: 724-225-6940
  • Fax: 724-225-6811
Mailing address:
  • Phone: 724-225-6940
  • Fax: 724-225-6811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC002742
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: