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NPI Code Detail

MEDICARE: HALIE ALEXIS NALL SUDRC

MEDICARE: HALIE ALEXIS NALL SUDRC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor20540CA

General Provider Information

NPI Number : 1811737422
Entity Type Code : Individual
Provider Name (Legal Business Name) : HALIE ALEXIS NALL SUDRC
Provider Business Mailing Address
First Line : 2885 FAIRVIEW RD APT E201
Second Line :
City : COSTA MESA
State : CA
Zip : 92626-4124
Country : US
Telephone Number : 310-908-1960
Fax Number :
Provider Business Practice Location Address
First Line : 12781 JOSEPHINE ST
Second Line :
City : GARDEN GROVE
State : CA
Zip : 92841-4622
Country : US
Telephone Number : 657-251-0503
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2024
Last Update Date : 02/26/2025

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Directions to “ HALIE ALEXIS NALL SUDRC” Practice Location

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