Provider Demographics
NPI:1326676701
Name:HALL, SHALETHA ROSHEL
Entity Type:Individual
Prefix:
First Name:SHALETHA
Middle Name:ROSHEL
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 1:1305 ARKANSAS BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-1691
Mailing Address - Country:US
Mailing Address - Phone:870-330-9702
Mailing Address - Fax:
Practice Address - Street 1:1305 ARKANSAS BLVD STE 104
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1691
Practice Address - Country:US
Practice Address - Phone:870-330-9702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health