MEDICARE: MRS. KAMEEL ALICIA HALL LCSW

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	1041C0700X	Clinical Social Worker	09040114444	VA

General Provider Information

NPI Number	:	1396378436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAMEEL ALICIA HALL LCSW

Provider Business Mailing Address
First Line	:	1765 E LITTLE CREEK RD APT 101
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23518-4212
Country	:	US
Telephone Number	:	646-346-9566
Fax Number	:

Provider Business Practice Location Address
First Line	:	1765 E LITTLE CREEK RD APT 101
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23518-4212
Country	:	US
Telephone Number	:	646-346-9566
Fax Number	:

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

Provider Enumeration Date	:	02/18/2020
Last Update Date	:	02/18/2020

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