Provider Demographics
NPI:1699898759
Name:HALL, ROBERT M III (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:HALL
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 TRIPLETT RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:NC
Mailing Address - Zip Code:27013-8724
Mailing Address - Country:US
Mailing Address - Phone:704-872-3608
Mailing Address - Fax:704-872-3688
Practice Address - Street 1:235 TRIPLETT RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:NC
Practice Address - Zip Code:27013-8724
Practice Address - Country:US
Practice Address - Phone:704-872-3608
Practice Address - Fax:704-872-3688
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC217103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000745Medicaid