=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518535582
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. LEA M HALL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2021
-----------------------------------------------------
Last Update Date | 06/15/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1101 MASSACHUSETS AVE NW
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-786-8822
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1971 ROCHELL AVE APT 4
-----------------------------------------------------
City | DISTRICT HEIGHTS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20747-1469
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-354-6709
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 372600000X
-----------------------------------------------------
Taxonomy Name | Adult Companion
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------