Provider Demographics
NPI:1255500286
Name:HALL, JAMILA CHAYA
Entity Type:Individual
Prefix:
First Name:JAMILA
Middle Name:CHAYA
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 AVONDALE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-2357
Mailing Address - Country:US
Mailing Address - Phone:919-358-8570
Mailing Address - Fax:
Practice Address - Street 1:1230 AVONDALE DR
Practice Address - Street 2:SUITE 114
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-2357
Practice Address - Country:US
Practice Address - Phone:919-358-8570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104478Medicaid