Basic Information
Provider Information
NPI: 1225435811
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DILLS
FirstName: LISA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 2187
Address2:  
City: SYLVA
State: NC
PostalCode: 287792187
CountryCode: US
TelephoneNumber: 8286313973
FaxNumber: 8286319280
Practice Location
Address1: 669 S HAYWOOD ST
Address2:  
City: WAYNESVILLE
State: NC
PostalCode: 287866703
CountryCode: US
TelephoneNumber: 8286313973
FaxNumber: 8286319280
Other Information
ProviderEnumerationDate: 11/25/2014
LastUpdateDate: 03/16/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000X  Y Behavioral Health & Social Service ProvidersCounselor 

No ID Information.


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