Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1673 | NC |
Y | 103T00000X | Psychologist | 1673 | NC |
N | 103TS0200X | School Psychologist | 1673 | NC |
NPI | 1104092501 |
---|---|
Provider Name | Dr. Stephen Robert Hillis |
First Address | Charlotte, NC 28277-3415 |
Second Address | Charlotte, NC 28277-3415 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2008 |
Last Update Date | 06/05/2008 |