Provider Demographics
NPI:1134942717
Name:HALL, SHACOYA RENEE
Entity type:Individual
Prefix:
First Name:SHACOYA
Middle Name:RENEE
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 1:2306 PROSE CIR APT 2306
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-1380
Mailing Address - Country:US
Mailing Address - Phone:404-915-7772
Mailing Address - Fax:
Practice Address - Street 1:2306 PROSE CIR APT 2306
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-1380
Practice Address - Country:US
Practice Address - Phone:404-915-7772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician