Provider Demographics
NPI:1205982444
Name:LILLY, PATRICIA ELIZABETH (BS, CCDC, CPC-AD)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ELIZABETH
Last Name:LILLY
Suffix:
Gender:F
Credentials:BS, CCDC, CPC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 HAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2022
Mailing Address - Country:US
Mailing Address - Phone:410-893-3896
Mailing Address - Fax:410-877-2936
Practice Address - Street 1:260 GATEWAY DR
Practice Address - Street 2:SUITE 18A
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4268
Practice Address - Country:US
Practice Address - Phone:410-893-3896
Practice Address - Fax:410-893-3896
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC0032101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)