Healthcare Provider Details

I. General information

NPI: 1144052580
Provider Name (Legal Business Name): TIMOTHY R HALL LPC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HEBRON AVE STE 201
GLASTONBURY CT
06033-2176
US

IV. Provider business mailing address

300 HEBRON AVE STE 201
GLASTONBURY CT
06033-2176
US

V. Phone/Fax

Practice location:
  • Phone: 860-946-0447
  • Fax: 860-781-8588
Mailing address:
  • Phone: 44-786-0946
  • Fax: 860-781-8588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7429
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: