Provider Demographics
NPI:1376284034
Name:HALL, SHANDREKA (DSW, LCSW)
Entity Type:Individual
Prefix:DR
First Name:SHANDREKA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:SHANDREKA
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4500 MERCANTILE PLAZA DR STE 300
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-4206
Mailing Address - Country:US
Mailing Address - Phone:682-233-2415
Mailing Address - Fax:
Practice Address - Street 1:4500 MERCANTILE PLAZA DR STE 300
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-4206
Practice Address - Country:US
Practice Address - Phone:682-233-2415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59404104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker