Provider Demographics
NPI:1013211713
Name:HALL, MIA YVETTE (DMFT & LCSW)
Entity Type:Individual
Prefix:DR
First Name:MIA
Middle Name:YVETTE
Last Name:HALL
Suffix:
Gender:F
Credentials:DMFT & LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 NORT SECOND STREET
Mailing Address - Street 2:SUITE301
Mailing Address - City:FT. PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950
Mailing Address - Country:US
Mailing Address - Phone:772-595-3773
Mailing Address - Fax:772-464-0087
Practice Address - Street 1:121 N 2ND ST
Practice Address - Street 2:SUITE301
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4435
Practice Address - Country:US
Practice Address - Phone:772-595-3773
Practice Address - Fax:772-464-0087
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW40231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical