MEDICARE: DAWN CHILLON PH.D, LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0701006286	VA

General Provider Information

NPI Number	:	1194180893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN CHILLON PH.D, LPC, NCC

Provider Business Mailing Address
First Line	:	3040 AVEMORE SQUARE PL
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22911-7228
Country	:	US
Telephone Number	:	804-901-7911
Fax Number	:	804-672-7422

Provider Business Practice Location Address
First Line	:	4112 E PARHAM RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-2753
Country	:	US
Telephone Number	:	804-901-7911
Fax Number	:	804-672-7422

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2015
Last Update Date	:	11/09/2020

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