Individual
MR. DEANTE DARNELL LILLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CT
Contact information
Practice address
28916 EUCLID AVE, WICKLIFFE, OH 44092-2531
(216) 532-5465
Mailing address
28916 EUCLID AVE, WICKLIFFE, OH 44092-2531
(216) 532-5465
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
C.2204108-TRNE
OH
Other
Enumeration date
03/15/2023
Last updated
03/15/2023
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