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General NPI Number Information
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NPI Number | 1588721997
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Entity Type | Individual
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Provider Name | JACK L HILEMAN LMFT
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Gender | Male
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 06/24/2019
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Provider Practice Location Address
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Address Line | 1451 S ELM EUGENE ST
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City | GREENSBORO
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State | NC
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Zip | 27406-2200
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Country | US
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Telephone | 336-202-0846
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Fax | 866-420-9205
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Provider Business Mailing Address
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Address Line | 1451 S ELM EUGENE ST UNIT 54
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City | GREENSBORO
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State | NC
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Zip | 27406-2392
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Country | US
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Telephone | 336-202-0846
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Fax | 866-420-9205
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1091
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License Number State | NC
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