Provider Demographics
NPI:1376958645
Name:DICKENSON-HALL, SHAYNE (MSW)
Entity Type:Individual
Prefix:MS
First Name:SHAYNE
Middle Name:
Last Name:DICKENSON-HALL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 103
Mailing Address - Street 2:568 RAVIN DR.
Mailing Address - City:HOONAH
Mailing Address - State:AK
Mailing Address - Zip Code:99829-0103
Mailing Address - Country:US
Mailing Address - Phone:907-945-2758
Mailing Address - Fax:907-945-3239
Practice Address - Street 1:222 TONGASS DR
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-9416
Practice Address - Country:US
Practice Address - Phone:907-945-2758
Practice Address - Fax:907-945-3239
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional