Provider Demographics
NPI:1497896377
Name:HALL-TERRY, NIKKI R (BS, CAC-1)
Entity Type:Individual
Prefix:MRS
First Name:NIKKI
Middle Name:R
Last Name:HALL-TERRY
Suffix:
Gender:F
Credentials:BS, CAC-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 STIMSON ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2410
Mailing Address - Country:US
Mailing Address - Phone:313-993-4700
Mailing Address - Fax:
Practice Address - Street 1:3840 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-1608
Practice Address - Country:US
Practice Address - Phone:313-331-8990
Practice Address - Fax:313-331-6375
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)