Provider Demographics
NPI:1902215288
Name:PRICE, JILL (LLBSW)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29240 BUCKINGHAM ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-4575
Mailing Address - Country:US
Mailing Address - Phone:734-513-2800
Mailing Address - Fax:
Practice Address - Street 1:29240 BUCKINGHAM ST
Practice Address - Street 2:SUITE 11
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-4575
Practice Address - Country:US
Practice Address - Phone:734-513-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802087797101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)