Provider Demographics
NPI:1295407914
Name:HALL, WINTER NOEL TUCKER (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:WINTER NOEL
Middle Name:TUCKER
Last Name:HALL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-3873
Mailing Address - Country:US
Mailing Address - Phone:314-295-1190
Mailing Address - Fax:
Practice Address - Street 1:1946 EDWARDSVILLE CLUB PLAZA CT
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3717
Practice Address - Country:US
Practice Address - Phone:618-248-2040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180013389101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional