Provider Demographics
NPI:1164652046
Name:HALL, WENDY L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:L
Last Name:HALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 W DEER TRAIL LN
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-6414
Mailing Address - Country:US
Mailing Address - Phone:352-746-1072
Mailing Address - Fax:352-746-7750
Practice Address - Street 1:2145 W NORVELL BRYANT HWY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-9437
Practice Address - Country:US
Practice Address - Phone:352-697-0705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-25
Last Update Date:2009-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 00044891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical