Healthcare Provider Details

I. General information

NPI: 1033897079
Provider Name (Legal Business Name): ALEXA K HALL ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4058 WILLOWS RD
ALPINE CA
91901-1668
US

IV. Provider business mailing address

4058 WILLOWS RD
ALPINE CA
91901-1668
US

V. Phone/Fax

Practice location:
  • Phone: 619-445-1188
  • Fax:
Mailing address:
  • Phone: 619-445-1188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number109170
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: