Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 0813000936 | VA |
NPI | 1073016234 |
---|---|
Provider Name | Nicole Dillon |
First Address | Midlothian, VA 23112-2004 |
Second Address | Midlothian, VA 23112-2004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2018 |
Last Update Date | 14/03/2018 |