Provider Demographics
NPI:1003037698
Name:HALL, SCOTT A (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:HALL
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4512 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-3514
Mailing Address - Country:US
Mailing Address - Phone:248-909-1869
Mailing Address - Fax:248-599-7392
Practice Address - Street 1:5869 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3357
Practice Address - Country:US
Practice Address - Phone:248-909-1869
Practice Address - Fax:248-605-8599
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MI6401010641101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)