Healthcare Provider Details

I. General information

NPI: 1942545371
Provider Name (Legal Business Name): MATTHEW W. HALL LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 MAIN STREET
EAST MACHIAS ME
04630
US

IV. Provider business mailing address

PO BOX 8
EAST MACHIAS ME
04630-0008
US

V. Phone/Fax

Practice location:
  • Phone: 207-726-8474
  • Fax:
Mailing address:
  • Phone: 207-726-8474
  • Fax: 888-518-2282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC4421
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: