Healthcare Provider Details

I. General information

NPI: 1568117844
Provider Name (Legal Business Name): DAMION DEMIS HALL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date: 05/21/2022
Reactivation Date: 06/27/2022

III. Provider practice location address

1600 E. BELLE TERRACE.
BAKERSFIELD CA
93307
US

IV. Provider business mailing address

PO BOX 1000
BAKERSFIELD CA
93302-1000
US

V. Phone/Fax

Practice location:
  • Phone: 661-635-2950
  • Fax:
Mailing address:
  • Phone: 661-868-6840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number135493
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: