=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063552644
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. CHARLESETTA HILL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2007
-----------------------------------------------------
Last Update Date | 06/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2500 WILSHIRE BLVD SUITE 500
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90057-4303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-639-0205
-----------------------------------------------------
Fax | 213-388-5749
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3940 GIBRALTAR AVE APT. 6
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90008-1265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-295-8360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225400000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------