Provider Demographics
NPI:1114232212
Name:HALL, KEVIN FARRIER (LCADC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:FARRIER
Last Name:HALL
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ARTHUR PL
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1707
Mailing Address - Country:US
Mailing Address - Phone:732-925-2060
Mailing Address - Fax:
Practice Address - Street 1:33 ARTHUR PL
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1707
Practice Address - Country:US
Practice Address - Phone:732-925-2060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00027200101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)