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General NPI Number Information
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NPI Number | 1497000319
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Entity Type | Organization
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Legal Business Name | THERAPIST WILMINGTON
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Dates
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Enumeration Date | 07/17/2012
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Last Update Date | 07/17/2012
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Provider Practice Location Address
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Address Line | 9404 VOYAGERS WAY
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City | WILMINGTON
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State | NC
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Zip | 28412-3442
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Country | US
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Telephone | 910-795-6677
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Fax |
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Provider Business Mailing Address
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Address Line | 9404 VOYAGERS WAY
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City | WILMINGTON
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State | NC
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Zip | 28412-3442
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Country | US
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Telephone | 910-795-6677
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. JON CHRISTOPHER HALL
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Credential | LCSW. PH.D.
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Telephone | 910-795-6677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | C005936
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | C005936
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C005936
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | C005936
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | C005936
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License Number State | NC
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Taxonomy #6
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | C005936
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License Number State | NC
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Taxonomy #7
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | C005936
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License Number State | NC
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Taxonomy #8
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | C005936
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License Number State | NC
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Taxonomy #9
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C005936
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License Number State | NC
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