Provider Demographics
NPI:1447848296
Name:HALL, SHAVON (LCSW)
Entity type:Individual
Prefix:
First Name:SHAVON
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:STE 203-BOX 257
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118
Mailing Address - Country:US
Mailing Address - Phone:318-572-4803
Mailing Address - Fax:
Practice Address - Street 1:40 BURTON HILLS BLVD STE 140
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-6186
Practice Address - Country:US
Practice Address - Phone:318-572-4803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA128431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical