Provider Demographics
NPI:1679360515
Name:HALL, EDDIE GENE JR (LMHC)
Entity type:Individual
Prefix:MR
First Name:EDDIE
Middle Name:GENE
Last Name:HALL
Suffix:JR
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 SW AMBERWOOD LOOP APT 105
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-6971
Mailing Address - Country:US
Mailing Address - Phone:904-868-6915
Mailing Address - Fax:
Practice Address - Street 1:3333 NE 39TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-2639
Practice Address - Country:US
Practice Address - Phone:352-491-4478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH25399101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health