Provider Demographics
NPI:1043347172
Name:HALL, LESHONE
Entity Type:Individual
Prefix:MR
First Name:LESHONE
Middle Name:
Last Name:HALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19855 OUTER DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2022
Mailing Address - Country:US
Mailing Address - Phone:313-274-5840
Mailing Address - Fax:313-274-8277
Practice Address - Street 1:13305 LA SALLE BLVD
Practice Address - Street 2:307
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-3599
Practice Address - Country:US
Practice Address - Phone:313-574-1960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010794391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical