Provider Demographics
NPI:1467996033
Name:SANDRA HALL, LMHC, CAP, CRC, PA
Entity Type:Organization
Organization Name:SANDRA HALL, LMHC, CAP, CRC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:SWARY
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, CAP, CRC
Authorized Official - Phone:727-623-0974
Mailing Address - Street 1:10825 SEMINOLE BLVD
Mailing Address - Street 2:UNIT 2A
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33778-3315
Mailing Address - Country:US
Mailing Address - Phone:727-623-0974
Mailing Address - Fax:727-623-0975
Practice Address - Street 1:10825 SEMINOLE BLVD
Practice Address - Street 2:UNIT 2A
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-3315
Practice Address - Country:US
Practice Address - Phone:727-623-0974
Practice Address - Fax:727-623-0975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 7586101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL767696400Medicaid