Provider Demographics
NPI:1164568325
Name:HALL, MYRON STACY (LPC)
Entity Type:Individual
Prefix:MR
First Name:MYRON
Middle Name:STACY
Last Name:HALL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 OAK GROVE CLOVER HILL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:NC
Mailing Address - Zip Code:28090-9693
Mailing Address - Country:US
Mailing Address - Phone:704-312-3922
Mailing Address - Fax:
Practice Address - Street 1:577 OAK GROVE CLOVER HILL CHURCH RD
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:NC
Practice Address - Zip Code:28090-9693
Practice Address - Country:US
Practice Address - Phone:704-312-3922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4999101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102865Medicaid