Provider Demographics
NPI:1679668644
Name:HILLIARD, SHIRLEY ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ANN
Last Name:HILLIARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2294
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39505-2294
Mailing Address - Country:US
Mailing Address - Phone:228-285-5247
Mailing Address - Fax:228-200-5204
Practice Address - Street 1:1403 43RD AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2545
Practice Address - Country:US
Practice Address - Phone:228-285-5247
Practice Address - Fax:228-200-5204
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC68161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00856758Medicaid