Provider Demographics
NPI:1003625708
Name:HALL, DIANDRA DANIELLE (BA, MA, LPC)
Entity type:Individual
Prefix:
First Name:DIANDRA
Middle Name:DANIELLE
Last Name:HALL
Suffix:
Gender:F
Credentials:BA, MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W POINTE DR STE D
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-8310
Mailing Address - Country:US
Mailing Address - Phone:618-641-3588
Mailing Address - Fax:618-671-6503
Practice Address - Street 1:209 W POINTE DR STE D
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-8310
Practice Address - Country:US
Practice Address - Phone:618-641-3588
Practice Address - Fax:618-671-6503
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.019289101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional