Provider Demographics
NPI:1013805902
Name:LILLY, JAMES DEAN (CDCA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DEAN
Last Name:LILLY
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 4TH ST E
Mailing Address - Street 2:
Mailing Address - City:SOUTH POINT
Mailing Address - State:OH
Mailing Address - Zip Code:45680-9430
Mailing Address - Country:US
Mailing Address - Phone:740-442-1747
Mailing Address - Fax:
Practice Address - Street 1:208 4TH ST E
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680-9430
Practice Address - Country:US
Practice Address - Phone:740-442-1747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH191214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)