Provider Demographics
NPI:1952972986
Name:HALL, CONNIE AURNETTE
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:AURNETTE
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 OAK MANOR DR APT 203
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5579
Mailing Address - Country:US
Mailing Address - Phone:443-963-7336
Mailing Address - Fax:
Practice Address - Street 1:307 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:MD
Practice Address - Zip Code:21225-3226
Practice Address - Country:US
Practice Address - Phone:410-551-3746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician