Provider Demographics
NPI:1669126116
Name:DILLON, KELSI MARIAH (MSW, LGSW)
Entity type:Individual
Prefix:MS
First Name:KELSI
Middle Name:MARIAH
Last Name:DILLON
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:KELSI
Other - Middle Name:MARIAH
Other - Last Name:HONAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LGSW
Mailing Address - Street 1:PO BOX 561
Mailing Address - Street 2:
Mailing Address - City:FAIRDALE
Mailing Address - State:WV
Mailing Address - Zip Code:25839-0561
Mailing Address - Country:US
Mailing Address - Phone:304-923-9167
Mailing Address - Fax:
Practice Address - Street 1:120 HARPER CT
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2650
Practice Address - Country:US
Practice Address - Phone:304-923-9167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVF793709104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV00506261436Medicaid