Provider Demographics
NPI:1043875149
Name:DILLINGHAM COUNSELING SERVICES
Entity type:Organization
Organization Name:DILLINGHAM COUNSELING SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LEONA
Authorized Official - Middle Name:JAN
Authorized Official - Last Name:DILLINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:812-437-1700
Mailing Address - Street 1:5200 WASHINGTON AVE STE D
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-4863
Mailing Address - Country:US
Mailing Address - Phone:812-437-1700
Mailing Address - Fax:812-437-1702
Practice Address - Street 1:5200 WASHINGTON AVE STE D
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-4863
Practice Address - Country:US
Practice Address - Phone:812-437-1700
Practice Address - Fax:812-437-1702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-03
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN340077004AOtherLCSW LICENSE