Provider Demographics
NPI:1316347818
Name:DILLARD, CHRISTIE ELIZABETH (LPCA)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:ELIZABETH
Last Name:DILLARD
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:E
Other - Last Name:GAIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 FERNBROOK PL
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-1816
Mailing Address - Country:US
Mailing Address - Phone:828-423-1311
Mailing Address - Fax:
Practice Address - Street 1:31 COLLEGE PL
Practice Address - Street 2:BUILDING C
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2483
Practice Address - Country:US
Practice Address - Phone:828-251-2882
Practice Address - Fax:828-251-4757
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11036101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA11036OtherSTATE LICENSING NUMBER