Provider Demographics
NPI:1699152983
Name:HILLERY, DEMEKA
Entity type:Individual
Prefix:
First Name:DEMEKA
Middle Name:
Last Name:HILLERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 MARTHA DR.
Mailing Address - Street 2:
Mailing Address - City:ST. MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31588
Mailing Address - Country:US
Mailing Address - Phone:912-882-8626
Mailing Address - Fax:
Practice Address - Street 1:205 MARTHA DR.
Practice Address - Street 2:
Practice Address - City:ST. MARYS
Practice Address - State:GA
Practice Address - Zip Code:31588
Practice Address - Country:US
Practice Address - Phone:912-882-8626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2018-08-08
Deactivation Date:2015-10-14
Deactivation Code:
Reactivation Date:2018-08-08
Provider Licenses
StateLicense IDTaxonomies
GA008392101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional