Provider Demographics
NPI:1447566161
Name:DAVRILL, HALLIE J (LMFT)
Entity Type:Individual
Prefix:
First Name:HALLIE
Middle Name:J
Last Name:DAVRILL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:HALLIE
Other - Middle Name:J
Other - Last Name:DAVENPORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 431
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95456-0431
Mailing Address - Country:US
Mailing Address - Phone:707-489-7484
Mailing Address - Fax:
Practice Address - Street 1:312 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437
Practice Address - Country:US
Practice Address - Phone:707-489-7484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97643106H00000X
CA69932106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist