Provider Demographics
NPI:1194703066
Name:HILL, MARK RANDOLPH (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:RANDOLPH
Last Name:HILL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 5922
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28813-5922
Mailing Address - Country:US
Mailing Address - Phone:828-684-9123
Mailing Address - Fax:828-684-9383
Practice Address - Street 1:6 HERMAN AVENUE EXT
Practice Address - Street 2:SUITE A
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-9106
Practice Address - Country:US
Practice Address - Phone:828-684-9123
Practice Address - Fax:828-684-9383
Is Sole Proprietor?:No
Enumeration Date:2006-01-02
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1858103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000174Medicaid
NC0364YOtherBCBSNC
NC0364YOtherBCBSNC