Provider Demographics
NPI:1417079591
Name:HALL, BRENDA SUE (CDP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:SUE
Last Name:HALL
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2806 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-6930
Mailing Address - Country:US
Mailing Address - Phone:360-770-2349
Mailing Address - Fax:
Practice Address - Street 1:2806 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-6930
Practice Address - Country:US
Practice Address - Phone:360-676-2187
Practice Address - Fax:360-676-2162
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00047204101Y00000X
WACP00005953101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)