Provider Demographics
NPI:1518129386
Name:DENNARD, LILLIE FAY (LLPC)
Entity Type:Individual
Prefix:
First Name:LILLIE
Middle Name:FAY
Last Name:DENNARD
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 COCHISE DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2361
Mailing Address - Country:US
Mailing Address - Phone:248-752-5080
Mailing Address - Fax:248-254-1736
Practice Address - Street 1:6130 COCHISE DR
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2361
Practice Address - Country:US
Practice Address - Phone:248-752-5080
Practice Address - Fax:248-254-1736
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009403101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional