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General NPI Number Information
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NPI Number | 1740769603
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Entity Type | Individual
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Provider Name | DINA ANNE HILARIS LMFT
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Gender | Female
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Dates
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Enumeration Date | 08/11/2018
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Last Update Date | 08/11/2018
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Provider Practice Location Address
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Address Line | 11198 LEE HWY STE D2
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City | FAIRFAX
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State | VA
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Zip | 22030-5009
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Country | US
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Telephone | 703-785-0031
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Fax |
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Provider Business Mailing Address
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Address Line | 4659 EGGLESTON TER
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City | FAIRFAX
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State | VA
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Zip | 22030-6274
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Country | US
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Telephone | 703-408-1577
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0717001499
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License Number State | VA
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