Provider Demographics
NPI:1306016985
Name:HALL, CECIL HAROLD (MS, LADC, NCC)
Entity Type:Individual
Prefix:
First Name:CECIL
Middle Name:HAROLD
Last Name:HALL
Suffix:
Gender:M
Credentials:MS, LADC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1194 MAIN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-2773
Mailing Address - Country:US
Mailing Address - Phone:802-748-5670
Mailing Address - Fax:802-748-5670
Practice Address - Street 1:1194 MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-2773
Practice Address - Country:US
Practice Address - Phone:802-748-5670
Practice Address - Fax:802-748-5670
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000096101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)