Provider Demographics
NPI:1962115212
Name:VANCE, HILLARY (LICSW)
Entity type:Individual
Prefix:
First Name:HILLARY
Middle Name:
Last Name:VANCE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 558 BOX 4146
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96375-0042
Mailing Address - Country:US
Mailing Address - Phone:706-363-7080
Mailing Address - Fax:
Practice Address - Street 1:70 VINNYS WAY
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-8903
Practice Address - Country:US
Practice Address - Phone:706-363-7080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500811851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical