Provider Demographics
NPI:1063841849
Name:HILL, CARLA JANE (LICSW)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:JANE
Last Name:HILL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 DAYTON AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6276
Mailing Address - Country:US
Mailing Address - Phone:651-605-6020
Mailing Address - Fax:651-323-2687
Practice Address - Street 1:1619 DAYTON AVE STE 303
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6276
Practice Address - Country:US
Practice Address - Phone:651-605-6020
Practice Address - Fax:651-323-2687
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN239461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical