Provider Demographics
NPI:1720226558
Name:HALL, MIDI DALE (MA, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:MIDI
Middle Name:DALE
Last Name:HALL
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 TAMIAMI TRL
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8102
Mailing Address - Country:US
Mailing Address - Phone:941-629-0440
Mailing Address - Fax:941-629-0159
Practice Address - Street 1:3400 TAMIAMI TRL
Practice Address - Street 2:SUITE 204
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8102
Practice Address - Country:US
Practice Address - Phone:941-629-0440
Practice Address - Fax:941-629-0159
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 9714101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health