Provider Demographics
NPI:1073739538
Name:HALL, ANDREA ANN (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:ANN
Last Name:HALL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MRS
Other - First Name:ANDREA
Other - Middle Name:ANN
Other - Last Name:EISELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:3153 W BEAL CITY RD
Mailing Address - Street 2:
Mailing Address - City:WEIDMAN
Mailing Address - State:MI
Mailing Address - Zip Code:48893-9757
Mailing Address - Country:US
Mailing Address - Phone:734-620-2743
Mailing Address - Fax:
Practice Address - Street 1:3153 W BEAL CITY RD
Practice Address - Street 2:
Practice Address - City:WEIDMAN
Practice Address - State:MI
Practice Address - Zip Code:48893-9757
Practice Address - Country:US
Practice Address - Phone:734-620-2743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1084155101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional