Healthcare Provider Details

I. General information

NPI: 1760469704
Provider Name (Legal Business Name): JENNIFER HILTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121A BELLEVUE RD
DUBLIN GA
31021-2998
US

IV. Provider business mailing address

2217 LORD RD
DUDLEY GA
31022-2434
US

V. Phone/Fax

Practice location:
  • Phone: 478-272-1190
  • Fax: 478-275-6509
Mailing address:
  • Phone: 478-875-3381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number002403
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: