Basic Information
| Provider Information | |||||||||
| NPI: | 1225102023 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MA LICENSED PSYCHOLO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4009 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253644009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043481288 | ||||||||
| FaxNumber: | 3043481262 | ||||||||
| Practice Location | |||||||||
| Address1: | 511 MORRIS STREET | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043410511 | ||||||||
| FaxNumber: | 3043410197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 271 | WV | X | Behavioral Health & Social Service Providers | Psychologist | 364SP0808X | 00133 | WV | X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 0165274000 | 05 | WV | MEDICAID |