Provider Demographics
NPI:1265939482
Name:HILL, MICHELLE ANTIONETTE (LPC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANTIONETTE
Last Name:HILL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 223
Mailing Address - Street 2:
Mailing Address - City:NORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23127-0223
Mailing Address - Country:US
Mailing Address - Phone:757-524-2650
Mailing Address - Fax:
Practice Address - Street 1:1769 JAMESTOWN RD STE 107
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185
Practice Address - Country:US
Practice Address - Phone:757-524-2650
Practice Address - Fax:757-210-4055
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
VA0701007587101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty