Provider Demographics
NPI:1568088870
Name:HALL, PHIL'LISA S
Entity Type:Individual
Prefix:
First Name:PHIL'LISA
Middle Name:S
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 12TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44703-1902
Mailing Address - Country:US
Mailing Address - Phone:234-804-3008
Mailing Address - Fax:234-804-3024
Practice Address - Street 1:906 12TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44703-1902
Practice Address - Country:US
Practice Address - Phone:234-804-3008
Practice Address - Fax:234-804-3024
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)