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General NPI Number Information
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NPI Number | 1164269361
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Entity Type | Individual
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Provider Name | DILLON MITCHELL MASSEY LADAC, LMSW, AADC,
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Gender | Male
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Dates
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Enumeration Date | 07/15/2024
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Last Update Date | 01/12/2025
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Provider Practice Location Address
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Address Line | 205 PROGRESS WAY SUITE 200 OFFICE 206
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City | BRYANT
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State | AR
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Zip | 72022
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Country | US
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Telephone | 501-946-6711
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Fax |
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Provider Business Mailing Address
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Address Line | 205 PROGRESS WAY SUITE 200 OFFICE 206
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City | BRYANT
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State | AR
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Zip | 72022-7034
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Country | US
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Telephone | 501-725-9098
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 22989-M
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 501L
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License Number State | AR
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