Healthcare Provider Details

I. General information

NPI: 1205730892
Provider Name (Legal Business Name): CURTIS LEE HALL JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1143 MISSOURI ST
FAIRFIELD CA
94533-6007
US

IV. Provider business mailing address

1143 MISSOURI ST
FAIRFIELD CA
94533-6007
US

V. Phone/Fax

Practice location:
  • Phone: 707-435-9911
  • Fax: 707-435-0704
Mailing address:
  • Phone: 707-435-9911
  • Fax: 707-435-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: