MEDICARE: DARRELL HITE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	13733	IL

General Provider Information

NPI Number	:	1578140216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARRELL HITE

Provider Business Mailing Address
First Line	:	4507 N STERLING AVE STE 210
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61615-3861
Country	:	US
Telephone Number	:	309-339-5835
Fax Number	:

Provider Business Practice Location Address
First Line	:	4507 N STERLING AVE STE 210
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61615-3861
Country	:	US
Telephone Number	:	309-339-5835
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2021
Last Update Date	:	03/27/2021

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Directions to “ DARRELL HITE ” Practice Location

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