Provider Demographics
NPI:1821502238
Name:HILL, ROMAN DALE
Entity Type:Individual
Prefix:
First Name:ROMAN
Middle Name:DALE
Last Name:HILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 SHIRLEY RD
Mailing Address - Street 2:
Mailing Address - City:BUNKIE
Mailing Address - State:LA
Mailing Address - Zip Code:71322-1545
Mailing Address - Country:US
Mailing Address - Phone:318-346-8001
Mailing Address - Fax:318-346-8005
Practice Address - Street 1:1140 SHIRLEY RD
Practice Address - Street 2:
Practice Address - City:BUNKIE
Practice Address - State:LA
Practice Address - Zip Code:71322-1545
Practice Address - Country:US
Practice Address - Phone:318-346-8001
Practice Address - Fax:318-346-8005
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
169507412OtherNPI
LA1544761Medicaid