Healthcare Provider Details

I. General information

NPI: 1801068143
Provider Name (Legal Business Name): DEANNA DILLARD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 09/07/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 CHERRY RD STE 201
ROCK HILL SC
29732-3118
US

IV. Provider business mailing address

790 OAK TRAIL DR
MARIETTA GA
30062-7502
US

V. Phone/Fax

Practice location:
  • Phone: 678-763-5994
  • Fax:
Mailing address:
  • Phone: 770-977-6866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9127
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: