Healthcare Provider Details

I. General information

NPI: 1114682127
Provider Name (Legal Business Name): JENNIE ANTOINETTE MIELE-HALL LADC, LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIE HALL LADC, LCAS

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 MINOR ST
NEW HAVEN CT
06519-1623
US

IV. Provider business mailing address

246 SEASIDE AVE
STAMFORD CT
06902-5466
US

V. Phone/Fax

Practice location:
  • Phone: 203-503-3350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number001608
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-28685
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: