Provider Demographics
NPI:1174255574
Name:HALL, CARMEN REBECCA (RBT)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:REBECCA
Last Name:HALL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 OPP AVE
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-3036
Mailing Address - Country:US
Mailing Address - Phone:334-658-4477
Mailing Address - Fax:
Practice Address - Street 1:109 ONEAL CT
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-3803
Practice Address - Country:US
Practice Address - Phone:334-379-1043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-26
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRBT-21-195181106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician