Provider Demographics
NPI:1114656857
Name:HALL, DESTINY JORDAN
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:JORDAN
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 WINDY DR
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-7692
Mailing Address - Country:US
Mailing Address - Phone:762-432-4012
Mailing Address - Fax:
Practice Address - Street 1:97 WINDY DR
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-7692
Practice Address - Country:US
Practice Address - Phone:762-432-4012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician