Provider Demographics
NPI:1063692234
Name:HALL, ANTHONY MARK (CADAC)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:MARK
Last Name:HALL
Suffix:
Gender:M
Credentials:CADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:755 SCOTT CIR
Mailing Address - Street 2:BLDG 559
Mailing Address - City:HICKAM AFB
Mailing Address - State:HI
Mailing Address - Zip Code:96853-5399
Mailing Address - Country:US
Mailing Address - Phone:808-449-0175
Mailing Address - Fax:808-449-0195
Practice Address - Street 1:755 SCOTT CIR
Practice Address - Street 2:BLDG 559
Practice Address - City:HICKAM AFB
Practice Address - State:HI
Practice Address - Zip Code:96853-5399
Practice Address - Country:US
Practice Address - Phone:808-449-0175
Practice Address - Fax:808-449-0195
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)