Provider Demographics
NPI:1871928697
Name:HALL, JOE NATHAN (BSW,CCS,LADAC,ACADC)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:NATHAN
Last Name:HALL
Suffix:
Gender:M
Credentials:BSW,CCS,LADAC,ACADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6841 W 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71602-8680
Mailing Address - Country:US
Mailing Address - Phone:870-879-1051
Mailing Address - Fax:870-879-0118
Practice Address - Street 1:6841 W 13TH AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71602-8680
Practice Address - Country:US
Practice Address - Phone:870-879-1051
Practice Address - Fax:870-879-0118
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility