Basic Information
| Provider Information | |||||||||
| NPI: | 1770767758 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MSW, LLMSW, QMRP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16200 19 MILE RD | ||||||||
| Address2: | |||||||||
| City: | CLINTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480381103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5862638700 | ||||||||
| FaxNumber: | 5862638719 | ||||||||
| Practice Location | |||||||||
| Address1: | 16200 19 MILE RD | ||||||||
| Address2: | |||||||||
| City: | CLINTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5862638700 | ||||||||
| FaxNumber: | 5862638719 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2007 | ||||||||
| LastUpdateDate: | 12/26/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | L1094777 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.