Healthcare Provider Details

I. General information

NPI: 1598124356
Provider Name (Legal Business Name): SHAVON LASHELLE HILL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 ARKANSAS BLVD
TEXARKANA AR
71854-1890
US

IV. Provider business mailing address

1202 N STATELINE
TEXARKANA AR
71854
US

V. Phone/Fax

Practice location:
  • Phone: 870-340-2636
  • Fax: 833-226-0134
Mailing address:
  • Phone: 870-774-0920
  • Fax: 870-774-0926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA1601009
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: