Provider Demographics
NPI:1093724940
Name:HALL, DENISE (PHD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6333 CENTER DR
Mailing Address - Street 2:BLDG 16
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4126
Mailing Address - Country:US
Mailing Address - Phone:757-252-9500
Mailing Address - Fax:757-962-9801
Practice Address - Street 1:6333 CENTER DR BLDG 16
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4126
Practice Address - Country:US
Practice Address - Phone:757-252-9500
Practice Address - Fax:757-962-9801
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004492103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010009219Medicaid
VA002272R32Medicare ID - Type Unspecified