Provider Demographics
NPI:1952740367
Name:HALLE, ANNETTE KAY (LSW)
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:KAY
Last Name:HALLE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MRS
Other - First Name:ANNETTE
Other - Middle Name:KAY
Other - Last Name:HALLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW
Mailing Address - Street 1:2026 FULTON RD NW
Mailing Address - Street 2:SUITEC
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-3564
Mailing Address - Country:US
Mailing Address - Phone:330-451-2060
Mailing Address - Fax:330-451-2061
Practice Address - Street 1:2026 FULTON RD NW
Practice Address - Street 2:SUITEC
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3564
Practice Address - Country:US
Practice Address - Phone:330-451-2060
Practice Address - Fax:330-451-2061
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1000333101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor