Healthcare Provider Details

I. General information

NPI: 1730748476
Provider Name (Legal Business Name): ANNE RENEE DILLARD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 POPLAR AVE STE 1118
MEMPHIS TN
38157-1118
US

IV. Provider business mailing address

5050 POPLAR AVE STE 1118
MEMPHIS TN
38157-1118
US

V. Phone/Fax

Practice location:
  • Phone: 901-683-5658
  • Fax:
Mailing address:
  • Phone: 901-683-5658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0000003945
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: