Provider Demographics
NPI:1114706322
Name:HALL, NYRISHA ANNIE
Entity Type:Individual
Prefix:
First Name:NYRISHA
Middle Name:ANNIE
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 1:5113 ROYAL BIRKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-5188
Mailing Address - Country:US
Mailing Address - Phone:716-880-9630
Mailing Address - Fax:
Practice Address - Street 1:1800 DIAGONAL RD STE 600
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2840
Practice Address - Country:US
Practice Address - Phone:703-283-6178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0709024954101YA0400X
VA0704016357101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health