Basic Information
Provider Information
NPI: 1740547660
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HILL
FirstName: DANNY
MiddleName: CHRISTOPHER
NamePrefix:  
NameSuffix:  
Credential: LCAS-P
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 355 S MADISON BLVD STE C
Address2:  
City: ROXBORO
State: NC
PostalCode: 275735485
CountryCode: US
TelephoneNumber: 3365145693
FaxNumber: 3363226168
Practice Location
Address1: 355 S MADISON BLVD STE C
Address2:  
City: ROXBORO
State: NC
PostalCode: 275735485
CountryCode: US
TelephoneNumber: 3365998366
FaxNumber: 3363226168
Other Information
ProviderEnumerationDate: 04/17/2012
LastUpdateDate: 04/18/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YA0400XLCAS-PNCY Behavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)

No ID Information.


Home