Provider Demographics
NPI:1164752309
Name:HALL, CALVIN L (LSW,LICDCSAP)
Entity Type:Individual
Prefix:MR
First Name:CALVIN
Middle Name:L
Last Name:HALL
Suffix:
Gender:M
Credentials:LSW,LICDCSAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10908 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-3529
Mailing Address - Country:US
Mailing Address - Phone:121-632-6251
Mailing Address - Fax:
Practice Address - Street 1:10908 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-3529
Practice Address - Country:US
Practice Address - Phone:121-632-6251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH944083101YA0400X
OHS28730104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker