Provider Demographics
NPI:1689483547
Name:DILLINGHAM, AMELIA LEE (LPC)
Entity type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:LEE
Last Name:DILLINGHAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15518 FOX GATE PL
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-6549
Mailing Address - Country:US
Mailing Address - Phone:804-464-7374
Mailing Address - Fax:
Practice Address - Street 1:12000 WYNDHAM LAKE DR STE B
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-7072
Practice Address - Country:US
Practice Address - Phone:804-592-2793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701014315101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional