Provider Demographics
NPI:1043296767
Name:HILL, BARBARA SUE (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:SUE
Last Name:HILL
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 VALENCIA DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7356
Mailing Address - Country:US
Mailing Address - Phone:910-346-9000
Mailing Address - Fax:910-355-0672
Practice Address - Street 1:200 VALENCIA DR
Practice Address - Street 2:SUITE 108
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6311
Practice Address - Country:US
Practice Address - Phone:910-346-9000
Practice Address - Fax:910-355-0672
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0015001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002641Medicaid
64306OtherBLUE CROSS
731666345OtherTAX ID
NC2863108BMedicare ID - Type Unspecified