Provider Demographics
NPI:1730622655
Name:HALL, THERESA REGINA
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:REGINA
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 MCARTHUR RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-6928
Mailing Address - Country:US
Mailing Address - Phone:910-491-0319
Mailing Address - Fax:800-948-6061
Practice Address - Street 1:5816 CREEDMOOR RD
Practice Address - Street 2:SUITE 104
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-2310
Practice Address - Country:US
Practice Address - Phone:919-665-4673
Practice Address - Fax:919-882-8348
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-25
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician