Provider Demographics
NPI:1750859609
Name:HALL, NICOLA J (LPC, CSAC, LMT)
Entity type:Individual
Prefix:DR
First Name:NICOLA
Middle Name:J
Last Name:HALL
Suffix:
Gender:F
Credentials:LPC, CSAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 KANAWAH RUN
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-2760
Mailing Address - Country:US
Mailing Address - Phone:757-876-4946
Mailing Address - Fax:
Practice Address - Street 1:204 KANAWAH RUN
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-2760
Practice Address - Country:US
Practice Address - Phone:757-876-4946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-08
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102956101YA0400X
VA0701006939101YP2500X, 101YM0800X
VA0019012154225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist