Provider Demographics
NPI:1164661492
Name:HALL, DENNIS DWAIN (LCDC)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:DWAIN
Last Name:HALL
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 MANCHACA RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1680
Mailing Address - Country:US
Mailing Address - Phone:512-383-1036
Mailing Address - Fax:512-383-1044
Practice Address - Street 1:4403 MANCHACA RD
Practice Address - Street 2:SUITE B
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1680
Practice Address - Country:US
Practice Address - Phone:512-383-1036
Practice Address - Fax:512-383-1044
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1531101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)