Provider Demographics
NPI:1992548648
Name:FAWCETT, DILLON (MA, TLMHC)
Entity type:Individual
Prefix:
First Name:DILLON
Middle Name:
Last Name:FAWCETT
Suffix:
Gender:M
Credentials:MA, TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CENTER POINT
Mailing Address - State:IA
Mailing Address - Zip Code:52213-9421
Mailing Address - Country:US
Mailing Address - Phone:319-981-0368
Mailing Address - Fax:
Practice Address - Street 1:2240 9TH ST
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1575
Practice Address - Country:US
Practice Address - Phone:319-800-5564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA121775101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health