Provider Demographics
NPI:1205479425
Name:DVORAK, HILLARY R (LCSW)
Entity type:Individual
Prefix:
First Name:HILLARY
Middle Name:R
Last Name:DVORAK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:HILLARY
Other - Middle Name:R
Other - Last Name:BRUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:371 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-1019
Mailing Address - Country:US
Mailing Address - Phone:619-322-7630
Mailing Address - Fax:
Practice Address - Street 1:3475 BELLE CHASE WAY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4252
Practice Address - Country:US
Practice Address - Phone:517-882-3732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0216521041C0700X
MI68011112771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical