Provider Demographics
NPI:1811607997
Name:DODGE HALL, DANIELL HELYNE (LCMHCA)
Entity type:Individual
Prefix:
First Name:DANIELL
Middle Name:HELYNE
Last Name:DODGE HALL
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2186 PINEY GROVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:KENLY
Mailing Address - State:NC
Mailing Address - Zip Code:27542-8384
Mailing Address - Country:US
Mailing Address - Phone:919-522-9078
Mailing Address - Fax:
Practice Address - Street 1:8325 HWY 70 BUSINESS, SUITE A-2
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520
Practice Address - Country:US
Practice Address - Phone:919-550-4910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18289101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health