Provider Demographics
NPI:1578140216
Name:HITE, DARRELL
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:
Last Name:HITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4507 N STERLING AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-3861
Mailing Address - Country:US
Mailing Address - Phone:309-339-5835
Mailing Address - Fax:
Practice Address - Street 1:4507 N STERLING AVE STE 210
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-3861
Practice Address - Country:US
Practice Address - Phone:309-339-5835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-27
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL13733101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)