Provider Demographics
NPI:1184041840
Name:HALL, DANA (MA, LCPC)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11309 DISTINCTIVE DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-9490
Mailing Address - Country:US
Mailing Address - Phone:708-691-9577
Mailing Address - Fax:
Practice Address - Street 1:11309 DISTINCTIVE DR # 11309
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-9490
Practice Address - Country:US
Practice Address - Phone:708-691-9577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007329101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional