Provider Demographics
NPI:1518181213
Name:KIMBERLY L. HILLERY & ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:KIMBERLY L. HILLERY & ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:LA SHARNE
Authorized Official - Last Name:HILLERY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-442-7300
Mailing Address - Street 1:28921 W. 7 MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3503
Mailing Address - Country:US
Mailing Address - Phone:248-442-7300
Mailing Address - Fax:248-442-1506
Practice Address - Street 1:28921 W 7 MILE ROAD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152
Practice Address - Country:US
Practice Address - Phone:248-442-7300
Practice Address - Fax:248-442-1506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YA0400X
MI6801087375104100000X, 1041C0700X
MI681087375104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP46370Medicare PIN