Provider Demographics
NPI:1538320643
Name:HALL, DIANA L (MFT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:L
Last Name:HALL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 DE ANZA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-3940
Mailing Address - Country:US
Mailing Address - Phone:650-574-2294
Mailing Address - Fax:650-574-2285
Practice Address - Street 1:1501 DE ANZA BLVD
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-3940
Practice Address - Country:US
Practice Address - Phone:650-574-2294
Practice Address - Fax:650-574-2285
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT32459106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist