Healthcare Provider Details

I. General information

NPI: 1962045245
Provider Name (Legal Business Name): SHARAE LACRASHA HILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2019
Last Update Date: 10/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15920 FENKELL ST
DETROIT MI
48227-1970
US

IV. Provider business mailing address

4291 WENDELL RD
WEST BLOOMFIELD MI
48323-3266
US

V. Phone/Fax

Practice location:
  • Phone: 313-220-2255
  • Fax:
Mailing address:
  • Phone: 313-220-2255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: