Provider Demographics
NPI:1427799444
Name:DILLINGHAM, ELIZABETH (LPCA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:DILLINGHAM
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7652
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-7652
Mailing Address - Country:US
Mailing Address - Phone:270-448-0961
Mailing Address - Fax:
Practice Address - Street 1:2000 BLOOM AVE
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-2632
Practice Address - Country:US
Practice Address - Phone:270-448-0961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY273714101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health