MEDICARE: AMANDA HALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1366376758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA HALL

Provider Business Mailing Address
First Line	:	694 CLARK HOUSE FARM RD
Second Line	:
City	:	STUART
State	:	VA
Zip	:	24171-4548
Country	:	US
Telephone Number	:	276-734-0080
Fax Number	:

Provider Business Practice Location Address
First Line	:	2609 N DUKE ST STE 603
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704-3019
Country	:	US
Telephone Number	:	615-560-6622
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2026
Last Update Date	:	06/10/2026

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Directions to “ AMANDA HALL ” Practice Location

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