=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710435516
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN DILLON HERNANDEZ MA, LCAS, LCMHCA, NC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2016
-----------------------------------------------------
Last Update Date | 06/15/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 811 CONOVER BLVD W
-----------------------------------------------------
City | CONOVER
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28613-2861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-610-1567
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1111 WINDY HILL DR NW
-----------------------------------------------------
City | CONOVER
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28613-9095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 286-101-5678
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | A15775
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 22569
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------