Provider Demographics
NPI:1467543116
Name:HALL, TYRINDA C (SOCIAL WORKER, LICSW)
Entity Type:Individual
Prefix:
First Name:TYRINDA
Middle Name:C
Last Name:HALL
Suffix:
Gender:F
Credentials:SOCIAL WORKER, LICSW
Other - Prefix:
Other - First Name:TYRINDA
Other - Middle Name:C
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW-PIP
Mailing Address - Street 1:PO BOX 640692
Mailing Address - Street 2:
Mailing Address - City:PIKE ROAD
Mailing Address - State:AL
Mailing Address - Zip Code:36064-0692
Mailing Address - Country:US
Mailing Address - Phone:334-413-7773
Mailing Address - Fax:
Practice Address - Street 1:2400 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083-5001
Practice Address - Country:US
Practice Address - Phone:334-727-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2373C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical