Provider Demographics
NPI:1770315756
Name:HILLOCK, MICHELLE E (LAC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:E
Last Name:HILLOCK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 EDGEMONT RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-2213
Mailing Address - Country:US
Mailing Address - Phone:551-579-2017
Mailing Address - Fax:
Practice Address - Street 1:522 S BROAD ST STE 7
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-1325
Practice Address - Country:US
Practice Address - Phone:201-241-2422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-17
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00809000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health