Provider Demographics
NPI:1164269361
Name:MASSEY, DILLON MITCHELL (LADAC, LMSW, AADC,)
Entity type:Individual
Prefix:MR
First Name:DILLON
Middle Name:MITCHELL
Last Name:MASSEY
Suffix:
Gender:M
Credentials:LADAC, LMSW, AADC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 PROGRESS WAY SUITE 200 OFFICE 206
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-7034
Mailing Address - Country:US
Mailing Address - Phone:501-725-9098
Mailing Address - Fax:
Practice Address - Street 1:205 PROGRESS WAY SUITE 200 OFFICE 206
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022
Practice Address - Country:US
Practice Address - Phone:501-946-6711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR22989-M104100000X
AR501L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker