Provider Demographics
NPI:1285801993
Name:HALL, NICOLE LYNN (MA,PC)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LYNN
Last Name:HALL
Suffix:
Gender:F
Credentials:MA,PC
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:LYNN
Other - Last Name:LUCKMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:5457 CREEKSIDE MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-0733
Mailing Address - Country:US
Mailing Address - Phone:513-289-7429
Mailing Address - Fax:513-881-7188
Practice Address - Street 1:1131 MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-1925
Practice Address - Country:US
Practice Address - Phone:513-422-7016
Practice Address - Fax:513-422-5263
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health