Provider Demographics
NPI:1932806957
Name:HILL, SHANDRIA DANIELLE (RBT)
Entity Type:Individual
Prefix:
First Name:SHANDRIA
Middle Name:DANIELLE
Last Name:HILL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 CATES RD
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-6942
Mailing Address - Country:US
Mailing Address - Phone:770-328-0858
Mailing Address - Fax:
Practice Address - Street 1:4143 COLUMBIA RD STE B
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-5405
Practice Address - Country:US
Practice Address - Phone:706-755-2785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-22-248173106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician