Provider Demographics
NPI:1740607134
Name:ST. HILLAIRE, ANGELA (PHD, LP, LPC)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:ST. HILLAIRE
Suffix:
Gender:F
Credentials:PHD, LP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8695 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1426
Mailing Address - Country:US
Mailing Address - Phone:269-240-8915
Mailing Address - Fax:
Practice Address - Street 1:8695 MEADOW LN
Practice Address - Street 2:
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103-1426
Practice Address - Country:US
Practice Address - Phone:269-240-8915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014020101YP2500X
MI6301019245103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional