Provider Demographics
NPI:1154143402
Name:DILLON, JILL MARIE (MS, ED S, NCSP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:DILLON
Suffix:
Gender:F
Credentials:MS, ED S, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 CEDAR RUN
Mailing Address - Street 2:
Mailing Address - City:POCOMOKE CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21851-1183
Mailing Address - Country:US
Mailing Address - Phone:757-894-7483
Mailing Address - Fax:
Practice Address - Street 1:800 8TH ST
Practice Address - Street 2:
Practice Address - City:POCOMOKE CITY
Practice Address - State:MD
Practice Address - Zip Code:21851-1573
Practice Address - Country:US
Practice Address - Phone:410-632-5150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23-4847103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool