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General NPI Number Information
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NPI Number | 1720723638
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Entity Type | Individual
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Provider Name | EBONYE R DILLARD LADAC II
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Gender | Female
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Dates
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Enumeration Date | 05/04/2022
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Last Update Date | 05/04/2022
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Provider Practice Location Address
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Address Line | 4065 CANE RIDGE PKWY APT 227
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City | ANTIOCH
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State | TN
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Zip | 37013-4742
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Country | US
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Telephone | 615-609-1652
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 22065
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City | NASHVILLE
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State | TN
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Zip | 37202-2065
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Country | US
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Telephone | 615-434-8195
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1271
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License Number State | TN
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