Provider Demographics
NPI:1063839645
Name:VANSICKLE, HILARY A (MA, TLLP)
Entity Type:Individual
Prefix:
First Name:HILARY
Middle Name:A
Last Name:VANSICKLE
Suffix:
Gender:F
Credentials:MA, TLLP
Other - Prefix:
Other - First Name:HILARY
Other - Middle Name:A
Other - Last Name:HOLLERBACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3400 S WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-4958
Mailing Address - Country:US
Mailing Address - Phone:989-755-1702
Mailing Address - Fax:989-755-1401
Practice Address - Street 1:3500 S WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-4958
Practice Address - Country:US
Practice Address - Phone:989-755-1072
Practice Address - Fax:989-755-1401
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015855101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)