Provider Demographics
NPI:1073600300
Name:HILLERY, KIMBERLY L (LMSW, ACSW, SAP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:L
Last Name:HILLERY
Suffix:
Gender:F
Credentials:LMSW, ACSW, SAP
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:L
Other - Last Name:HILLERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:28800 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3557
Mailing Address - Country:US
Mailing Address - Phone:248-442-7300
Mailing Address - Fax:248-442-1506
Practice Address - Street 1:28800 7 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3557
Practice Address - Country:US
Practice Address - Phone:248-442-7300
Practice Address - Fax:248-442-1506
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YP2500X, 104100000X, 1041C0700X, 101YA0400X
MI6801087375104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical