Basic Information
| Provider Information | |||||||||
| NPI: | 1326028101 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LILLARD | ||||||||
| FirstName: | DORIS | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7310 WHITE DR | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725229722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707998118 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1507 N PECAN ST | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721122867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8705233643 | ||||||||
| FaxNumber: | 8705238224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | P9808021 | AR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.