Provider Demographics
NPI:1508458043
Name:HALL, DEAN THOMAS (SUD COUNSELOR, CADC)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:THOMAS
Last Name:HALL
Suffix:
Gender:M
Credentials:SUD COUNSELOR, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 461713
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92046-1713
Mailing Address - Country:US
Mailing Address - Phone:619-602-1421
Mailing Address - Fax:
Practice Address - Street 1:73 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-1124
Practice Address - Country:US
Practice Address - Phone:619-426-4801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA043980317101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)