Provider Demographics
NPI:1588721997
Name:HILEMAN, JACK L (LMFT)
Entity type:Individual
Prefix:MR
First Name:JACK
Middle Name:L
Last Name:HILEMAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:MR
Other - First Name:JACK
Other - Middle Name:L
Other - Last Name:HILEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:1451 S ELM EUGENE ST UNIT 54
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-2392
Mailing Address - Country:US
Mailing Address - Phone:336-202-0846
Mailing Address - Fax:866-420-9205
Practice Address - Street 1:1451 S ELM EUGENE ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-2200
Practice Address - Country:US
Practice Address - Phone:336-202-0846
Practice Address - Fax:866-420-9205
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1091106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105060Medicaid