Provider Demographics
NPI:1154790392
Name:HALL, CHRISTINA (MED, QMHP)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:MED, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 TAFT AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-6666
Mailing Address - Country:US
Mailing Address - Phone:847-621-2040
Mailing Address - Fax:
Practice Address - Street 1:1585 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-4978
Practice Address - Country:US
Practice Address - Phone:847-621-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health