Healthcare Provider Details

I. General information

NPI: 1205386661
Provider Name (Legal Business Name): MRS. LAURIE HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 INTERNATIONAL BLVD
OAKLAND CA
94621-2843
US

IV. Provider business mailing address

7501 INTERNATIONAL BLVD
OAKLAND CA
94621-2843
US

V. Phone/Fax

Practice location:
  • Phone: 510-835-9610
  • Fax: 510-569-4965
Mailing address:
  • Phone: 510-835-9610
  • Fax: 510-569-4965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: