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General NPI Number Information
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NPI Number | 1912843962
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Entity Type | Individual
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Provider Name | CARISSA MARIE DILLINGER LAAC15454
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Gender | Female
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Dates
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Enumeration Date | 04/23/2026
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Last Update Date | 04/23/2026
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Provider Practice Location Address
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Address Line | 7802 N 43RD AVE STE 5
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City | GLENDALE
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State | AZ
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Zip | 85301-8111
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Country | US
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Telephone | 623-215-1212
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Fax |
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Provider Business Mailing Address
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Address Line | 1450 E BELL RD APT 2027
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City | PHOENIX
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State | AZ
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Zip | 85022-2762
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Country | US
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Telephone | 602-877-1175
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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 | LAAC15454
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License Number State | AZ
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