Provider Demographics
NPI:1578150314
Name:HALL, TREDELLA LATINA
Entity Type:Individual
Prefix:
First Name:TREDELLA
Middle Name:LATINA
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 1:838 WOOLARD CRES
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1382
Mailing Address - Country:US
Mailing Address - Phone:757-318-1643
Mailing Address - Fax:
Practice Address - Street 1:900 COMMONWEALTH PL
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4517
Practice Address - Country:US
Practice Address - Phone:757-318-1643
Practice Address - Fax:757-378-6953
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710103526101YA0400X
VA0701010264101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)