Provider Demographics
NPI:1104786201
Name:LEARN INSPIRE THRIVE-LIT TEEN SUBSTANCE USE PROGRAM
Entity type:Organization
Organization Name:LEARN INSPIRE THRIVE-LIT TEEN SUBSTANCE USE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HILLIARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS-A
Authorized Official - Phone:910-550-4768
Mailing Address - Street 1:PO BOX 15003
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28408-5003
Mailing Address - Country:US
Mailing Address - Phone:910-550-4768
Mailing Address - Fax:877-497-5618
Practice Address - Street 1:1202 N ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-2704
Practice Address - Country:US
Practice Address - Phone:910-550-4768
Practice Address - Fax:877-497-5618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-12
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty