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General NPI Number Information
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NPI Number | 1336897198
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Entity Type | Organization
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Legal Business Name | BRENDA W. DILLINGHAM LMFT, LLC
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Dates
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Enumeration Date | 03/11/2022
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Last Update Date | 03/11/2022
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Provider Practice Location Address
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Address Line | 11108 WARM WIND WAY
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City | WEEKI WACHEE
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State | FL
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Zip | 34613-6520
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Country | US
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Telephone | 352-340-5321
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Fax |
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Provider Business Mailing Address
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Address Line | BRENDA W DILLINGHAM PTY 13518 2250 NW 114TH AVE UNIT 1P
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City | MIAMI
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State | FL
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Zip | 33192-4177
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Country | US
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Telephone | 352-340-5321
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRENDA WALKER DILLINGHAM
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Credential | PHD, MS, LMFT
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Telephone | 352-340-5321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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