Provider Demographics
NPI:1598871667
Name:HALL, SUSAN PAIGE (LCPC, CADC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:PAIGE
Last Name:HALL
Suffix:
Gender:F
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 W CANTRELL ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62522-9778
Mailing Address - Country:US
Mailing Address - Phone:217-872-1700
Mailing Address - Fax:217-872-1366
Practice Address - Street 1:3040 N UNIVERSITY AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-1391
Practice Address - Country:US
Practice Address - Phone:217-872-1700
Practice Address - Fax:217-872-1366
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL21183101YA0400X
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional