Healthcare Provider Details

I. General information

NPI: 1891012134
Provider Name (Legal Business Name): FATIMA QUIBELLA MAYO-HILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

467 N STATE ST
CARO MI
48723-1539
US

IV. Provider business mailing address

443 N STATE ST
CARO MI
48723-1539
US

V. Phone/Fax

Practice location:
  • Phone: 989-673-5700
  • Fax: 989-672-2017
Mailing address:
  • Phone: 989-672-6160
  • Fax: 989-672-5649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401010709
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: