Provider Demographics
NPI:1962138610
Name:HILL, LOLITA R (RSPS, QMHP, PSS)
Entity type:Individual
Prefix:
First Name:LOLITA
Middle Name:R
Last Name:HILL
Suffix:
Gender:F
Credentials:RSPS, QMHP, PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PMB 1000 4830 WILSON RD STE 300
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396
Mailing Address - Country:US
Mailing Address - Phone:832-597-5106
Mailing Address - Fax:
Practice Address - Street 1:2325 ATASCOCITA RD STE 5C
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-4634
Practice Address - Country:US
Practice Address - Phone:936-257-3078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
05494-050175T00000X
TX05494-0522171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171400000XOther Service ProvidersHealth & Wellness Coach
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX50494-0522OtherTCB
TX50190-0822OtherTCB