Provider Demographics
NPI:1013640010
Name:HILL, EMMA LEE
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:LEE
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14485 SENECA RD APT 112
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-9350
Mailing Address - Country:US
Mailing Address - Phone:760-284-2689
Mailing Address - Fax:
Practice Address - Street 1:628 PINGREE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2024
Practice Address - Country:US
Practice Address - Phone:313-932-5527
Practice Address - Fax:313-731-1991
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451011207101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor