Provider Demographics
NPI:1043917479
Name:HALL, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
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 1:901 H ST NE APT 701
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-7054
Mailing Address - Country:US
Mailing Address - Phone:202-294-6742
Mailing Address - Fax:
Practice Address - Street 1:3 WASHINGTON CIR NW STE 204
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2326
Practice Address - Country:US
Practice Address - Phone:202-644-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGPC10665101YM0800X
DCLGPC00765101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD10665OtherLGPC
DC00765OtherLGPC