Provider Demographics
NPI:1124603766
Name:HILLIARD-THOMAS, DESTINY J T (LGPC)
Entity Type:Individual
Prefix:MRS
First Name:DESTINY
Middle Name:J T
Last Name:HILLIARD-THOMAS
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12358 BONFIRE DR
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-1712
Mailing Address - Country:US
Mailing Address - Phone:732-533-3806
Mailing Address - Fax:
Practice Address - Street 1:12358 BONFIRE DR
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-1712
Practice Address - Country:US
Practice Address - Phone:732-533-3806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP11211101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor