Healthcare Provider Details

I. General information

NPI: 1992101810
Provider Name (Legal Business Name): INDIRA HALL L.M.S.W, LCSW, M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KEITH R. HALL LLMSW

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4523 HIGHLAND RD
WATERFORD MI
48328-1132
US

IV. Provider business mailing address

4523 HIGHLAND RD
WATERFORD MI
48328-1132
US

V. Phone/Fax

Practice location:
  • Phone: 248-470-3003
  • Fax:
Mailing address:
  • Phone: 248-470-3003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801035457
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: