Provider Demographics
NPI:1962681031
Name:HILL, STACIA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:STACIA
Middle Name:L
Last Name:HILL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11763 KITTERY DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7862
Mailing Address - Country:US
Mailing Address - Phone:317-915-5066
Mailing Address - Fax:
Practice Address - Street 1:2511 E 46TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2460
Practice Address - Country:US
Practice Address - Phone:317-273-8897
Practice Address - Fax:317-273-8862
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041861A103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling