Provider Demographics
NPI:1104528207
Name:VICK, DILLAN LEE (BEHAVIOR TECHNICIAN)
Entity type:Individual
Prefix:MR
First Name:DILLAN
Middle Name:LEE
Last Name:VICK
Suffix:
Gender:M
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10767 GRAVEL RD
Mailing Address - Street 2:
Mailing Address - City:BRANDY STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22714-1872
Mailing Address - Country:US
Mailing Address - Phone:540-738-7720
Mailing Address - Fax:
Practice Address - Street 1:767 MADISON RD STE 110
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3340
Practice Address - Country:US
Practice Address - Phone:540-738-7220
Practice Address - Fax:540-779-0728
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician