Provider Demographics
NPI:1740769603
Name:HILARIS, DINA ANNE (LMFT)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:ANNE
Last Name:HILARIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4659 EGGLESTON TER
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6274
Mailing Address - Country:US
Mailing Address - Phone:703-408-1577
Mailing Address - Fax:
Practice Address - Street 1:11198 LEE HWY STE D2
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5009
Practice Address - Country:US
Practice Address - Phone:703-785-0031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-11
Last Update Date:2018-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001499106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist