Provider Demographics
NPI:1407205180
Name:HALL, MICHELE (LMSW, BHP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:LMSW, BHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3022 E LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-3898
Mailing Address - Country:US
Mailing Address - Phone:480-335-2117
Mailing Address - Fax:
Practice Address - Street 1:31687 N ROYAL OAK WAY
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-6341
Practice Address - Country:US
Practice Address - Phone:480-335-2117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-03
Last Update Date:2022-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801100165104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker