Basic Information
| Provider Information | |||||||||
| NPI: | 1649373143 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HILL | ||||||||
| FirstName: | GABRIELLE | ||||||||
| MiddleName: | MILDRED | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RN,B.S. CAC -R | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1255 JOANWOOD DR | ||||||||
| Address2: | |||||||||
| City: | MARYSVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480402025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103880184 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 400 STODDARD RD | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480622505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103922167 | ||||||||
| FaxNumber: | 8103922057 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 02/10/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 2-00474 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.