Provider Demographics
NPI:1124487905
Name:DILLON, ANDREA D
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:D
Last Name:DILLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 JENKINS AVE
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-4955
Mailing Address - Country:US
Mailing Address - Phone:520-237-0542
Mailing Address - Fax:
Practice Address - Street 1:206 E REYNOLDS DR
Practice Address - Street 2:SUITE F
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270
Practice Address - Country:US
Practice Address - Phone:318-224-7017
Practice Address - Fax:318-254-7053
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2018-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health