Provider Demographics
NPI:1518477322
Name:DILLARD, TRACY (LMHC, NCC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:DILLARD
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 NAMAHANA ST APT 10
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-2168
Mailing Address - Country:US
Mailing Address - Phone:808-371-7035
Mailing Address - Fax:
Practice Address - Street 1:437 NAMAHANA ST APT 10
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-2168
Practice Address - Country:US
Practice Address - Phone:315-254-9246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-06
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
HIMHC-689101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health