Healthcare Provider Details

I. General information

NPI: 1275448995
Provider Name (Legal Business Name): DILLON LOUIS SHASH M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 WASHINGTON ST
RAVENSWOOD WV
26164-1729
US

IV. Provider business mailing address

705 WASHINGTON ST
RAVENSWOOD WV
26164-1729
US

V. Phone/Fax

Practice location:
  • Phone: 304-868-6000
  • Fax: 304-868-6002
Mailing address:
  • Phone: 304-868-6000
  • Fax: 304-868-6002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: