Basic Information
| Provider Information | |||||||||
| NPI: | 1164756896 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DILDINE | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | LPCC-S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11263 RIVER RD | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435229338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198321029 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 FREEDOM DR | ||||||||
| Address2: | |||||||||
| City: | NAPOLEON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435459038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195991660 | ||||||||
| FaxNumber: | 4195928336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2009 | ||||||||
| LastUpdateDate: | 09/29/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | E3260-S | OH | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.