Provider Demographics
NPI:1497181960
Name:HILL, DEMETRIA MIRANDA (LPC)
Entity Type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:MIRANDA
Last Name:HILL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 DEBORAH DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2022
Mailing Address - Country:US
Mailing Address - Phone:229-375-2266
Mailing Address - Fax:229-375-2266
Practice Address - Street 1:2321 DEBORAH DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2022
Practice Address - Country:US
Practice Address - Phone:229-375-2266
Practice Address - Fax:229-239-0018
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008049101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health