Provider Demographics
NPI:1780836007
Name:HILLAIRE, JAMES REYNOLDS JR (CDP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:REYNOLDS
Last Name:HILLAIRE
Suffix:JR
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7727 21ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:TULALIP
Mailing Address - State:WA
Mailing Address - Zip Code:98271-6960
Mailing Address - Country:US
Mailing Address - Phone:425-971-0049
Mailing Address - Fax:
Practice Address - Street 1:6700 TOTEM BEACH RD
Practice Address - Street 2:
Practice Address - City:TULALIP
Practice Address - State:WA
Practice Address - Zip Code:98271-9714
Practice Address - Country:US
Practice Address - Phone:350-651-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00000242101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)