Provider Demographics
NPI:1992819379
Name:HALL, JAMES (PHD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:HALL
Suffix:
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:PO BOX 63314
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3454
Mailing Address - Country:US
Mailing Address - Phone:828-696-1312
Mailing Address - Fax:828-696-1314
Practice Address - Street 1:709 N JUSTICE ST
Practice Address - Street 2:SUITE B
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3454
Practice Address - Country:US
Practice Address - Phone:828-696-1234
Practice Address - Fax:828-696-1257
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2570103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000618Medicaid
NC2879834BMedicare ID - Type Unspecified