Provider Demographics
NPI:1922247964
Name:LILLEY, DORENE K (MA, LLP)
Entity Type:Individual
Prefix:
First Name:DORENE
Middle Name:K
Last Name:LILLEY
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 N LIVERNOIS RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1001
Mailing Address - Country:US
Mailing Address - Phone:248-495-0132
Mailing Address - Fax:
Practice Address - Street 1:71 N LIVERNOIS RD
Practice Address - Street 2:SUITE F
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-1001
Practice Address - Country:US
Practice Address - Phone:248-495-0132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007714103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling