Healthcare Provider Details

I. General information

NPI: 1841964046
Provider Name (Legal Business Name): JENNIFER HALL MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10003 WEBSTER RD
CAMDEN ON GAULEY WV
26208-7713
US

IV. Provider business mailing address

PO BOX 420
CANVAS WV
26662-0420
US

V. Phone/Fax

Practice location:
  • Phone: 304-226-5725
  • Fax:
Mailing address:
  • Phone: 304-651-8718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number25317
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberDP00943287
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: