Provider Demographics
NPI:1477840312
Name:HALL, ANDREA J (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:HALL
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 NEWFOUND HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-2839
Mailing Address - Country:US
Mailing Address - Phone:321-848-4168
Mailing Address - Fax:
Practice Address - Street 1:2820 BUSINESS CENTER BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7103
Practice Address - Country:US
Practice Address - Phone:321-799-1863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10672101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional