Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003158650 |
---|---|
Provider Name | Robert Lovus Dillon II |
First Address | Dixon, IL 61021-1657 |
Second Address | Dixon, IL 61021-9118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2013 |
Last Update Date | 21/03/2013 |