Provider Demographics
NPI:1730265018
Name:HILL, ODEATHER ALLEN (PHD, LMSW, CSW, CD)
Entity type:Individual
Prefix:
First Name:ODEATHER
Middle Name:ALLEN
Last Name:HILL
Suffix:
Gender:F
Credentials:PHD, LMSW, CSW, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17314 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3158
Mailing Address - Country:US
Mailing Address - Phone:734-421-7772
Mailing Address - Fax:734-421-7776
Practice Address - Street 1:17314 FARMINGTON ROAD
Practice Address - Street 2:303
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152
Practice Address - Country:US
Practice Address - Phone:734-421-7772
Practice Address - Fax:734-421-7776
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801014771101Y00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor