Provider Demographics
NPI:1154623031
Name:HILLIS, NICOLE (LLMSW)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:HILLIS
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 W. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MI
Mailing Address - Zip Code:49247
Mailing Address - Country:US
Mailing Address - Phone:517-448-6442
Mailing Address - Fax:517-306-6164
Practice Address - Street 1:306 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MI
Practice Address - Zip Code:49247
Practice Address - Country:US
Practice Address - Phone:517-448-6442
Practice Address - Fax:517-306-6164
Is Sole Proprietor?:No
Enumeration Date:2010-11-26
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010925661041C0700X
MI1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical