MEDICARE: MR. EDWARD CURRUTH HILL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	0711000410	VA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1063159390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWARD CURRUTH HILL

Provider Business Mailing Address
First Line	:	3108 N PARHAM RD
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23294-4421
Country	:	US
Telephone Number	:	804-508-0904
Fax Number	:

Provider Business Practice Location Address
First Line	:	3108 N PARHAM RD
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23294-4408
Country	:	US
Telephone Number	:	804-508-0904
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2022
Last Update Date	:	10/11/2022

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