Provider Demographics
NPI:1518042068
Name:HALL, HOLLIE M (LMHC)
Entity Type:Individual
Prefix:MS
First Name:HOLLIE
Middle Name:M
Last Name:HALL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 HARRIGAN GULLY RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:NY
Mailing Address - Zip Code:14806-9696
Mailing Address - Country:US
Mailing Address - Phone:607-478-5424
Mailing Address - Fax:
Practice Address - Street 1:4220 STATE RTE 417 W
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-9332
Practice Address - Country:US
Practice Address - Phone:585-593-6300
Practice Address - Fax:585-593-7071
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001519101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001519OtherMENTAL HEALTH COUNSELING