Provider Demographics
NPI:1467496927
Name:HALL, SHIRLEY JEAN (LISW)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:JEAN
Last Name:HALL
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:SHIRLS
Other - Middle Name:JEAN
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISW
Mailing Address - Street 1:501 TIMBERLEA TRAIL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1981
Mailing Address - Country:US
Mailing Address - Phone:757-303-3672
Mailing Address - Fax:937-296-0198
Practice Address - Street 1:701 TIMBERLEA TRAIL
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-1981
Practice Address - Country:US
Practice Address - Phone:757-303-3672
Practice Address - Fax:757-289-2778
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2010-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040063071041C0700X
OHI 10001451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical