Basic Information
| Provider Information | |||||||||
| NPI: | 1609381060 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HILLAIRE | ||||||||
| FirstName: | DOROTHY | ||||||||
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| Credential: | LICDC, LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2419 DERBYSHIRE RD | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND HTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441062725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2169540444 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1302 WINSLOW AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441132336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2167810550 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2017 | ||||||||
| LastUpdateDate: | 11/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | S.1700716 | OH | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YA0400X | LICDC.161501 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.