Provider Demographics
NPI:1598124356
Name:HILL, SHAVON LASHELLE (LPC)
Entity Type:Individual
Prefix:MS
First Name:SHAVON
Middle Name:LASHELLE
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 1:1202 N STATELINE
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854
Mailing Address - Country:US
Mailing Address - Phone:870-774-0920
Mailing Address - Fax:870-774-0926
Practice Address - Street 1:1305 ARKANSAS BLVD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1890
Practice Address - Country:US
Practice Address - Phone:870-340-2636
Practice Address - Fax:833-226-0134
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1601009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA1601009Medicaid