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General NPI Number Information
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NPI Number | 1689483547
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Entity Type | Individual
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Provider Name | AMELIA LEE DILLINGHAM LPC
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Gender | Female
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 12000 WYNDHAM LAKE DR STE B
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City | GLEN ALLEN
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State | VA
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Zip | 23059-7072
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Country | US
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Telephone | 804-592-2793
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Fax |
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Provider Business Mailing Address
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Address Line | 15518 FOX GATE PL
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-6549
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Country | US
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Telephone | 804-464-7374
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701014315
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License Number State | VA
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