Provider Demographics
NPI:1619607207
Name:HALL, MANDY K
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:K
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:PO BOX 30022
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72260-0001
Mailing Address - Country:US
Mailing Address - Phone:501-455-8554
Mailing Address - Fax:870-770-7177
Practice Address - Street 1:103 CALVARY LN
Practice Address - Street 2:
Practice Address - City:JUDSONIA
Practice Address - State:AR
Practice Address - Zip Code:72081-9324
Practice Address - Country:US
Practice Address - Phone:501-720-0777
Practice Address - Fax:870-770-7177
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2401007101YP2500X
ARP2401007101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional