=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063069185
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HILL CITY COUNSELING AND CONSULTING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2019
-----------------------------------------------------
Last Update Date | 08/22/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1610A GRAVES MILL RD
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24502-4329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-258-0591
-----------------------------------------------------
Fax | 434-608-0505
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1610A GRAVES MILL RD
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24502-4329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-258-0591
-----------------------------------------------------
Fax | 434-608-0505
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SUZANNE E. MIKKELSON
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 434-258-0591
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------