Provider Demographics
NPI:1174793756
Name:HILLARY, MARCIA AMANDA (PHD)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:AMANDA
Last Name:HILLARY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 IRON POINT RD
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-8013
Mailing Address - Country:US
Mailing Address - Phone:916-990-7733
Mailing Address - Fax:
Practice Address - Street 1:1024 IRON POINT RD
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-8013
Practice Address - Country:US
Practice Address - Phone:916-990-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical