Provider Demographics
NPI:1720672728
Name:HILL, GRACE (QBHP)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:QBHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203B WESTPORT DR
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-3657
Mailing Address - Country:US
Mailing Address - Phone:501-843-9233
Mailing Address - Fax:501-843-9656
Practice Address - Street 1:350 SALEM RD STE 9
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-7521
Practice Address - Country:US
Practice Address - Phone:501-336-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
ARPLMSW104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR261708795Medicaid