Provider Demographics
NPI:1922443605
Name:HILL, TEQUILLA L (LMFT, PHD)
Entity Type:Individual
Prefix:
First Name:TEQUILLA
Middle Name:L
Last Name:HILL
Suffix:
Gender:F
Credentials:LMFT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 POWERS FERRY RD SE
Mailing Address - Street 2:BUILDING 27, SUITE 200
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-5491
Mailing Address - Country:US
Mailing Address - Phone:678-383-9564
Mailing Address - Fax:
Practice Address - Street 1:1640 POWERS FERRY RD SE
Practice Address - Street 2:BUILDING 27, SUITE 200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5491
Practice Address - Country:US
Practice Address - Phone:678-383-9564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001243106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist