MEDICARE: VICTORIA HALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6451022080	MI

General Provider Information

NPI Number	:	1588420723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA HALL

Provider Business Mailing Address
First Line	:	8765 LEWIS AVE
Second Line	:
City	:	TEMPERANCE
State	:	MI
Zip	:	48182-9583
Country	:	US
Telephone Number	:	734-847-3802
Fax Number	:	734-847-3418

Provider Business Practice Location Address
First Line	:	5650 CARLETON ROCKWOOD RD RM 100
Second Line	:
City	:	SOUTH ROCKWOOD
State	:	MI
Zip	:	48179-9764
Country	:	US
Telephone Number	:	734-847-3802
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2024
Last Update Date	:	02/26/2024

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Directions to “ VICTORIA HALL ” Practice Location

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