=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174516793
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GREGORY M. HILLIKER MSW, LCSW, LMFT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2005
-----------------------------------------------------
Last Update Date | 09/06/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4011 VILLAGE DR
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48507-5558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-235-2500
-----------------------------------------------------
Fax | 810-234-6635
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6465 FLAGSTONE CT
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48433-2585
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-235-2500
-----------------------------------------------------
Fax | 810-234-6635
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 6801005800
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 4101005556
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------