Provider Demographics
NPI:1487023719
Name:HILL, MARIE BRYAN (BCABA)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:BRYAN
Last Name:HILL
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 MASON CT
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-9302
Mailing Address - Country:US
Mailing Address - Phone:601-668-6949
Mailing Address - Fax:
Practice Address - Street 1:20 PARKWAY BLVD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-8879
Practice Address - Country:US
Practice Address - Phone:601-255-5264
Practice Address - Fax:566-625-0559
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0-10-3981103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst