Provider Demographics
NPI:1962178343
Name:HALL, RENEE' NICOLE
Entity type:Individual
Prefix:
First Name:RENEE'
Middle Name:NICOLE
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8208 HARVEST BEND LN APT 33
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-6138
Mailing Address - Country:US
Mailing Address - Phone:330-261-6671
Mailing Address - Fax:
Practice Address - Street 1:1405 BRENTWOOD PKWY NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-2220
Practice Address - Country:US
Practice Address - Phone:202-505-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool