Healthcare Provider Details

I. General information

NPI: 1629643432
Provider Name (Legal Business Name): SHIRLEY HILLIARD LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1636 POPPS FERRY RD STE 105
BILOXI MS
39532-2214
US

IV. Provider business mailing address

PO BOX 2294
GULFPORT MS
39505-2294
US

V. Phone/Fax

Practice location:
  • Phone: 228-285-5247
  • Fax:
Mailing address:
  • Phone: 228-285-5247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SHIRLEY ANN HILLIARD
Title or Position: OWNER
Credential:
Phone: 228-285-5247