Provider Demographics
NPI:1548922784
Name:HILL, JESIKA LAURIN (BCBA)
Entity type:Individual
Prefix:
First Name:JESIKA
Middle Name:LAURIN
Last Name:HILL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 SERENITY PATH
Mailing Address - Street 2:
Mailing Address - City:INMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29349-9313
Mailing Address - Country:US
Mailing Address - Phone:864-316-7014
Mailing Address - Fax:
Practice Address - Street 1:207 SERENITY PATH
Practice Address - Street 2:
Practice Address - City:INMAN
Practice Address - State:SC
Practice Address - Zip Code:29349-9313
Practice Address - Country:US
Practice Address - Phone:864-316-7014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1-21-53938103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst