Provider Demographics
NPI:1821327578
Name:HALL, MAZELLA B (PHD MSW LCSW)
Entity Type:Individual
Prefix:DR
First Name:MAZELLA
Middle Name:B
Last Name:HALL
Suffix:
Gender:F
Credentials:PHD MSW LCSW
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 61783
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27715
Mailing Address - Country:US
Mailing Address - Phone:919-680-0515
Mailing Address - Fax:919-286-2907
Practice Address - Street 1:919 BROAD STREET
Practice Address - Street 2:SUITE1
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705
Practice Address - Country:US
Practice Address - Phone:919-680-0515
Practice Address - Fax:919-286-2907
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0030031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical