Provider Demographics
NPI:1588464796
Name:AVERY, DILLAN (MSED)
Entity type:Individual
Prefix:MRS
First Name:DILLAN
Middle Name:
Last Name:AVERY
Suffix:
Gender:
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CHISHOLM PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5467
Mailing Address - Country:US
Mailing Address - Phone:774-280-9379
Mailing Address - Fax:
Practice Address - Street 1:100 SAUNDERS ST
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3826
Practice Address - Country:US
Practice Address - Phone:508-738-7720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician