Provider Demographics
NPI:1891424842
Name:HALL, PARIS AYANA (AMFT, APCC)
Entity Type:Individual
Prefix:
First Name:PARIS
Middle Name:AYANA
Last Name:HALL
Suffix:
Gender:F
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5386 GLENWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:EL SOBRANTE
Mailing Address - State:CA
Mailing Address - Zip Code:94803-3891
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2484 SHATTUCK AVE
Practice Address - Street 2:210
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2076
Practice Address - Country:US
Practice Address - Phone:510-704-7475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13014101YP2500X
CA135271106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional