Healthcare Provider Details

I. General information

NPI: 1528896065
Provider Name (Legal Business Name): MADISON HILT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32006 HARPER AVE
SAINT CLAIR SHORES MI
48082-1419
US

IV. Provider business mailing address

29666 PINTO DR
WARREN MI
48093-8606
US

V. Phone/Fax

Practice location:
  • Phone: 586-697-2324
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401226506
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: