Provider Demographics
NPI:1124884853
Name:EDENFIELD, HILLARY J (LAPC)
Entity type:Individual
Prefix:
First Name:HILLARY
Middle Name:J
Last Name:EDENFIELD
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 EUREKA CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30461-7613
Mailing Address - Country:US
Mailing Address - Phone:912-512-5938
Mailing Address - Fax:
Practice Address - Street 1:123 S ZETTEROWER AVE
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-4898
Practice Address - Country:US
Practice Address - Phone:912-225-3760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8929101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional