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General NPI Number Information
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NPI Number | 1790246973
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Entity Type | Individual
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Provider Name | GINGER LANE HALL
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Gender | Female
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Dates
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Enumeration Date | 03/28/2019
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Last Update Date | 03/28/2019
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Provider Practice Location Address
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Address Line | 12741 DARBY BROOK CT
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City | WOODBRIDGE
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State | VA
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Zip | 22192-2406
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Country | US
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Telephone | 703-203-3144
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Fax | 703-817-9890
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Provider Business Mailing Address
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Address Line | 12322 RUNNING DEER RD
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City | MANASSAS
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State | VA
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Zip | 20112-3203
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Country | US
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Telephone | 703-203-3144
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Fax | 703-817-9890
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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 | 0701008207
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License Number State | VA
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