Healthcare Provider Details

I. General information

NPI: 1205696895
Provider Name (Legal Business Name): STEVEN DENNIS HALL MA,LLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 LEDYARD ST
DETROIT MI
48201-2641
US

IV. Provider business mailing address

445 LEDYARD ST
DETROIT MI
48201-2641
US

V. Phone/Fax

Practice location:
  • Phone: 313-962-9446
  • Fax: 313-502-5147
Mailing address:
  • Phone: 313-962-9446
  • Fax: 313-502-5147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6451023422
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: