Provider Demographics
NPI:1912426206
Name:DILLARD, EVELYN (CADC,CPSS,RCP)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:DILLARD
Suffix:
Gender:
Credentials:CADC,CPSS,RCP
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:
Other - Last Name:PARROTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADC,CPSS,RCP
Mailing Address - Street 1:113 RIVERIA RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6856
Mailing Address - Country:US
Mailing Address - Phone:704-402-9176
Mailing Address - Fax:
Practice Address - Street 1:113 RIVERIA RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8974
Practice Address - Country:US
Practice Address - Phone:704-402-9176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCADC-24111101YA0400X
106S00000X, 171M00000X
NC175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1316335128Medicaid
NC1912426206Medicaid