Provider Demographics
NPI:1134458649
Name:HASTINGS-STORER, JILL MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:MARIE
Last Name:HASTINGS-STORER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:HASTINGS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:104 LAKE POINT DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-1930
Mailing Address - Country:US
Mailing Address - Phone:770-214-0470
Mailing Address - Fax:
Practice Address - Street 1:104 LAKE POINT DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-1930
Practice Address - Country:US
Practice Address - Phone:770-214-0470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA841106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist