Provider Demographics
NPI:1972511434
Name:HALL, JAMES (LADC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:HALL
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1512
Mailing Address - Country:US
Mailing Address - Phone:612-977-1821
Mailing Address - Fax:612-236-1700
Practice Address - Street 1:1132 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1512
Practice Address - Country:US
Practice Address - Phone:612-977-1821
Practice Address - Fax:612-236-1700
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3000921101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN22893OtherHP
MN84-61062OtherUBH
MN57422KUOtherBCBS