MEDICARE: MS. TRACI MONIQUE 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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1407155310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRACI MONIQUE HALL

Provider Business Mailing Address
First Line	:	7224 EAST SOUTHGATE DRIVE
Second Line	:	SUITE 100
City	:	SACRAMENTO
State	:	CA
Zip	:	95823
Country	:	US
Telephone Number	:	916-394-1000
Fax Number	:	916-394-1010

Provider Business Practice Location Address
First Line	:	7224 E. SOUTHGATE DR. STE. 100
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823
Country	:	US
Telephone Number	:	916-394-1000
Fax Number	:	916-394-1010

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

Provider Enumeration Date	:	03/17/2011
Last Update Date	:	03/17/2011

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