Provider Demographics
NPI:1881933745
Name:HALL, ANDREA MICHELLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MICHELLE
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 1:133 SW 120TH WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-8033
Mailing Address - Country:US
Mailing Address - Phone:954-260-7839
Mailing Address - Fax:
Practice Address - Street 1:7880 N UNIVERSITY DR
Practice Address - Street 2:SUITE 303
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2124
Practice Address - Country:US
Practice Address - Phone:954-260-7839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 112171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical