Provider Demographics
NPI:1861934374
Name:HILL, JEFFERY A II (CATC #5995-R)
Entity type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:A
Last Name:HILL
Suffix:II
Gender:M
Credentials:CATC #5995-R
Other - Prefix:MR
Other - First Name:JEFFERY
Other - Middle Name:A
Other - Last Name:HILL
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:ICPRS #PRS0030316
Mailing Address - Street 1:1817 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-5102
Mailing Address - Country:US
Mailing Address - Phone:562-507-0526
Mailing Address - Fax:
Practice Address - Street 1:600 E 7TH ST STE 105
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90021-1439
Practice Address - Country:US
Practice Address - Phone:213-537-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5995-R101YA0400X
CAPRS0030316106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5995-ROtherCAADE/CATC
CAPRS000030316OtherCCAPP-INTERNATIONALLY CERTIFIED PEER RECOVERY SPECIALIST (CPRS/ICPRS)