Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 249 | GA |
NPI | 1003915695 |
---|---|
Provider Name | Mr. Kenneth Hill |
First Address | Dublin, GA 31021 |
Second Address | Dublin, GA 31021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 08/07/2007 |