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General NPI Number Information
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NPI Number | 1619607207
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Entity Type | Individual
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Provider Name | MANDY K HALL
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Gender | Female
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Dates
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Enumeration Date | 06/15/2022
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Last Update Date | 03/12/2024
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Provider Practice Location Address
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Address Line | 103 CALVARY LN
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City | JUDSONIA
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State | AR
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Zip | 72081-9324
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Country | US
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Telephone | 501-720-0777
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Fax | 870-770-7177
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Provider Business Mailing Address
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Address Line | PO BOX 30022
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City | LITTLE ROCK
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State | AR
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Zip | 72260-0001
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Country | US
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Telephone | 501-455-8554
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Fax | 870-770-7177
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | A2401007
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P2401007
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License Number State | AR
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