Provider Demographics
NPI:1609577006
Name:HALL, MARQUITA RENEE (CDCA, PEER SUPPORTER)
Entity Type:Individual
Prefix:
First Name:MARQUITA
Middle Name:RENEE
Last Name:HALL
Suffix:
Gender:F
Credentials:CDCA, PEER SUPPORTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5689 AVERY RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-8765
Mailing Address - Country:US
Mailing Address - Phone:614-505-0378
Mailing Address - Fax:614-505-0399
Practice Address - Street 1:5689 AVERY RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-8765
Practice Address - Country:US
Practice Address - Phone:614-505-0378
Practice Address - Fax:614-505-0399
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH181646101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)