Healthcare Provider Details

I. General information

NPI: 1215744487
Provider Name (Legal Business Name): ALISHA HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 OHEAR AVE STE 100
NORTH CHARLESTON SC
29405-5091
US

IV. Provider business mailing address

4900 OHEAR AVE STE 100
NORTH CHARLESTON SC
29405-5091
US

V. Phone/Fax

Practice location:
  • Phone: 843-934-7575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: