Provider Demographics
NPI:1487996047
Name:DILLE, LISA ANNE (PC, LCDC III)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANNE
Last Name:DILLE
Suffix:
Gender:F
Credentials:PC, LCDC III
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:ANNE
Other - Last Name:BATEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PC, LCDC III
Mailing Address - Street 1:1705 INDIAN WOOD CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-4046
Mailing Address - Country:US
Mailing Address - Phone:419-969-7243
Mailing Address - Fax:419-750-1977
Practice Address - Street 1:4334 SECOR RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623
Practice Address - Country:US
Practice Address - Phone:419-475-6478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH121014101YA0400X
OHC.0800032101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)