Provider Demographics
NPI:1639964323
Name:HILL, ISHMUS LAWANZO JR (LCSW)
Entity type:Individual
Prefix:
First Name:ISHMUS
Middle Name:LAWANZO
Last Name:HILL
Suffix:JR
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6512 SHEPHERD OAKS RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-3164
Mailing Address - Country:US
Mailing Address - Phone:863-709-3779
Mailing Address - Fax:
Practice Address - Street 1:6512 SHEPHERD OAKS RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811-3164
Practice Address - Country:US
Practice Address - Phone:863-709-3779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-12
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL199121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical