Provider Demographics
NPI:1285342840
Name:HILL, MELISSA ANN (LLC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:HILL
Suffix:
Gender:F
Credentials:LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 BRICKLEY ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1114
Mailing Address - Country:US
Mailing Address - Phone:313-520-8086
Mailing Address - Fax:
Practice Address - Street 1:17360 W 12 MILE RD STE 102
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2117
Practice Address - Country:US
Practice Address - Phone:313-583-7090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-11
Last Update Date:2023-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022690101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional