Provider Demographics
NPI:1003523101
Name:DEMARE HALLY, DEANA
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:
Last Name:DEMARE HALLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5945 INNISVALE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-1107
Mailing Address - Country:US
Mailing Address - Phone:703-401-5745
Mailing Address - Fax:
Practice Address - Street 1:5945 INNISVALE DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX STATION
Practice Address - State:VA
Practice Address - Zip Code:22039-1107
Practice Address - Country:US
Practice Address - Phone:703-401-5745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach