Provider Demographics
NPI:1649373143
Name:HILL, GABRIELLE MILDRED (RN,BS CAC -R)
Entity type:Individual
Prefix:MRS
First Name:GABRIELLE
Middle Name:MILDRED
Last Name:HILL
Suffix:
Gender:F
Credentials:RN,BS CAC -R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 JOANWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48040-2025
Mailing Address - Country:US
Mailing Address - Phone:810-388-0184
Mailing Address - Fax:
Practice Address - Street 1:400 STODDARD RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MI
Practice Address - Zip Code:48062-2505
Practice Address - Country:US
Practice Address - Phone:810-392-2167
Practice Address - Fax:810-392-2057
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2-00474101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)