Provider Demographics
NPI:1790246973
Name:HALL, GINGER LANE
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:LANE
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 1:12322 RUNNING DEER RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-3203
Mailing Address - Country:US
Mailing Address - Phone:703-203-3144
Mailing Address - Fax:703-817-9890
Practice Address - Street 1:12741 DARBY BROOK CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2406
Practice Address - Country:US
Practice Address - Phone:703-203-3144
Practice Address - Fax:703-817-9890
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008207101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional