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General NPI Number Information
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NPI Number | 1164733275
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Entity Type | Individual
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Provider Name | JILL HAIRE M.A., L.M.H.C.
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Gender | Female
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Dates
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Enumeration Date | 06/24/2010
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Last Update Date | 06/24/2010
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Provider Practice Location Address
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Address Line | 4700 MILLENIA LAKES BLVD. SUITE 175
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City | ORLANDO
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State | FL
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Zip | 32839-6015
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Country | US
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Telephone | 407-340-6074
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Fax | 407-210-3901
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Provider Business Mailing Address
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Address Line | 7618 PISSARRO DR APT 308
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City | ORLANDO
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State | FL
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Zip | 32819-7352
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Country | US
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Telephone | 407-340-6074
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Fax | 407-210-3901
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 222315
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 4016
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH8833
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License Number State | FL
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