Provider Demographics
NPI:1356626006
Name:HILLMAN, KILA SOPHIA (MA, LPCC)
Entity type:Individual
Prefix:
First Name:KILA
Middle Name:SOPHIA
Last Name:HILLMAN
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SCENIC MESA RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-1458
Mailing Address - Country:US
Mailing Address - Phone:505-919-8037
Mailing Address - Fax:
Practice Address - Street 1:17 SCENIC MESA RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-1458
Practice Address - Country:US
Practice Address - Phone:505-919-8037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0185581101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM09703101Medicaid