Provider Demographics
NPI:1255453916
Name:HALL, VICKI L (MA LPC)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:L
Last Name:HALL
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 ELMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-4127
Mailing Address - Country:US
Mailing Address - Phone:517-787-7920
Mailing Address - Fax:517-787-2440
Practice Address - Street 1:142 E MAUMEE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-2735
Practice Address - Country:US
Practice Address - Phone:517-263-2625
Practice Address - Fax:517-263-7369
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006181101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional