Provider Demographics
NPI:1871622175
Name:HALL, SHARON K (LCSW)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:K
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 1:1026 W 11 MILE RD STE C
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-5403
Mailing Address - Country:US
Mailing Address - Phone:248-399-7711
Mailing Address - Fax:
Practice Address - Street 1:1026 W 11 MILE RD STE C
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-5403
Practice Address - Country:US
Practice Address - Phone:248-399-7711
Practice Address - Fax:248-547-1936
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010599521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0891215Medicare ID - Type Unspecified