Provider Demographics
NPI:1598972028
Name:HALL, LORI L (LMSW, LMFT, CAC-II)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:L
Last Name:HALL
Suffix:
Gender:F
Credentials:LMSW, LMFT, CAC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15721 ROSEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-1329
Mailing Address - Country:US
Mailing Address - Phone:313-273-4535
Mailing Address - Fax:
Practice Address - Street 1:380 N OLD WOODWARD AVE
Practice Address - Street 2:SUITE 234
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-5347
Practice Address - Country:US
Practice Address - Phone:248-642-6878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006205106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist