Provider Demographics
NPI:1518100106
Name:HILL, TERRY L JR (LSW,PC,LCDC III)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:L
Last Name:HILL
Suffix:JR
Gender:M
Credentials:LSW,PC,LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 HAWTHORN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-8341
Mailing Address - Country:US
Mailing Address - Phone:937-286-8214
Mailing Address - Fax:
Practice Address - Street 1:19 HAWTHORN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-8341
Practice Address - Country:US
Practice Address - Phone:937-286-8214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-12
Last Update Date:2009-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011304101YA0400X
OHC0028343101YM0800X
OHOH1-40-3916101YS0200X
OHS28343104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker