Basic Information
Provider Information
NPI: 1265629489
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HILL
FirstName: BELINDA
MiddleName: TRACY
NamePrefix: MS.
NameSuffix:  
Credential: CADC II A050510918
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1207 E FRUIT ST
Address2:  
City: SANTA ANA
State: CA
PostalCode: 927014296
CountryCode: US
TelephoneNumber: 7149539373
FaxNumber:  
Practice Location
Address1: 1207 E FRUIT ST
Address2:  
City: SANTA ANA
State: CA
PostalCode: 927014296
CountryCode: US
TelephoneNumber: 7149539373
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/02/2007
LastUpdateDate: 03/29/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/29/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YA0400XA050510918CAY Behavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)

No ID Information.


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