Provider Demographics
NPI:1174093397
Name:DILLINGHAM, KELLI MARSEA (CSAC)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:MARSEA
Last Name:DILLINGHAM
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ROBERTS RD # 6
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-8699
Mailing Address - Country:US
Mailing Address - Phone:828-505-3086
Mailing Address - Fax:282-274-6377
Practice Address - Street 1:6 ROBERTS RD # 6
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-8699
Practice Address - Country:US
Practice Address - Phone:828-505-3086
Practice Address - Fax:282-274-6377
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)