Provider Demographics
NPI:1306335633
Name:HALL, ANDREA JENELLA (LLPC)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:JENELLA
Last Name:HALL
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25790 BRANCHASTER RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-1643
Mailing Address - Country:US
Mailing Address - Phone:248-558-0183
Mailing Address - Fax:
Practice Address - Street 1:33634 W 8 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-5202
Practice Address - Country:US
Practice Address - Phone:734-219-5004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health