Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 CAMINO DEL RIO S STE 320
SAN DIEGO CA
92108-4107
US

IV. Provider business mailing address

4025 CAMINO DEL RIO S STE 320
SAN DIEGO CA
92108-4107
US

V. Phone/Fax

Practice location:
  • Phone: 619-688-8303
  • Fax: 619-492-4317
Mailing address:
  • Phone: 619-688-8303
  • Fax: 619-492-4317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number131070
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: