Provider Demographics
NPI:1710603618
Name:HILLARD, BLYTHE
Entity Type:Individual
Prefix:
First Name:BLYTHE
Middle Name:
Last Name:HILLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BLYTHE
Other - Middle Name:
Other - Last Name:CROSLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1513 HERITAGE LN
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-3141
Mailing Address - Country:US
Mailing Address - Phone:803-757-1744
Mailing Address - Fax:800-557-0208
Practice Address - Street 1:1513 HERITAGE LN
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-3141
Practice Address - Country:US
Practice Address - Phone:803-757-1744
Practice Address - Fax:800-557-0208
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician