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General NPI Number Information
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NPI Number | 1124603766
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Entity Type | Individual
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Provider Name | DESTINY J T HILLIARD-THOMAS LCPC
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Gender | Female
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Dates
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Enumeration Date | 03/15/2021
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 711 W 40TH ST STE 206
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City | BALTIMORE
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State | MD
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Zip | 21211-2108
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Country | US
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Telephone | 410-842-6055
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Fax |
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Provider Business Mailing Address
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Address Line | 12358 BONFIRE DR
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City | REISTERSTOWN
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State | MD
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Zip | 21136-1712
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Country | US
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Telephone | 732-533-3806
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC13621
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LC13621
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LC13621
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License Number State | MD
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