Healthcare Provider Details

I. General information

NPI: 1326636648
Provider Name (Legal Business Name): DEMAINE TERRENCE HILL LCSWA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DEMAINE TERRENCE HILL LCSWA

II. Dates (important events)

Enumeration Date: 01/03/2021
Last Update Date: 01/03/2021
Certification Date: 01/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 E KING ST
EDENTON NC
27932-1956
US

IV. Provider business mailing address

85 MACKEYS RD
PLYMOUTH NC
27962-9609
US

V. Phone/Fax

Practice location:
  • Phone: 252-217-8583
  • Fax:
Mailing address:
  • Phone: 252-217-8583
  • 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:
Title or Position:
Credential:
Phone: