Provider Demographics
NPI:1225522832
Name:HALL, KELDRICK DEMON
Entity Type:Individual
Prefix:
First Name:KELDRICK
Middle Name:DEMON
Last Name:HALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 METRO DR STE C1
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3446
Mailing Address - Country:US
Mailing Address - Phone:318-625-7467
Mailing Address - Fax:318-625-7420
Practice Address - Street 1:1403 METRO DR STE C1
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3446
Practice Address - Country:US
Practice Address - Phone:318-625-7467
Practice Address - Fax:318-625-7420
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor