Provider Demographics
NPI:1053813949
Name:HILL, LISSA LORRAINE-LYNCH (SUDCC)
Entity Type:Individual
Prefix:
First Name:LISSA
Middle Name:LORRAINE-LYNCH
Last Name:HILL
Suffix:
Gender:F
Credentials:SUDCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 PLEASANT VALLEY RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DIAMOND SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95619-4406
Mailing Address - Country:US
Mailing Address - Phone:530-344-2831
Mailing Address - Fax:
Practice Address - Street 1:484 PLEASANT VALLEY RD. #4
Practice Address - Street 2:
Practice Address - City:ELDORADO
Practice Address - State:CA
Practice Address - Zip Code:95619-9561
Practice Address - Country:US
Practice Address - Phone:530-344-7633
Practice Address - Fax:530-497-5202
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10845101YA0400X
CAR1323840918101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)