Provider Demographics
NPI:1457973356
Name:HILL, SHONNA MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHONNA
Middle Name:MARIE
Last Name:HILL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6095
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92834-6095
Mailing Address - Country:US
Mailing Address - Phone:231-545-6931
Mailing Address - Fax:
Practice Address - Street 1:135 S STATE COLLEGE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5805
Practice Address - Country:US
Practice Address - Phone:213-545-6931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31517103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling