Provider Demographics
NPI:1659045128
Name:MADDOX, HILLERIE BLACK (LPC)
Entity Type:Individual
Prefix:
First Name:HILLERIE
Middle Name:BLACK
Last Name:MADDOX
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 1:7045 SHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-2326
Mailing Address - Country:US
Mailing Address - Phone:267-978-7939
Mailing Address - Fax:
Practice Address - Street 1:7045 SHERWOOD RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-2326
Practice Address - Country:US
Practice Address - Phone:267-978-7939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-06
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
PAPC002742101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional