Healthcare Provider Details

I. General information

NPI: 1003908302
Provider Name (Legal Business Name): SHARON MARIE DILLINGER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16218 PACIFIC AVE S STE B2
SPANAWAY WA
98387-8612
US

IV. Provider business mailing address

16218 PACIFIC AVE S STE B2
SPANAWAY WA
98387-8612
US

V. Phone/Fax

Practice location:
  • Phone: 253-548-8824
  • Fax: 253-548-3040
Mailing address:
  • Phone: 253-548-8824
  • Fax: 253-548-3040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00003540
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: