Provider Demographics
NPI:1730772435
Name:HALL, DATINA
Entity type:Individual
Prefix:MRS
First Name:DATINA
Middle Name:
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 1:133 OLD SOLOMONS ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3825
Mailing Address - Country:US
Mailing Address - Phone:410-266-9747
Mailing Address - Fax:410-266-9749
Practice Address - Street 1:133 OLD SOLOMONS ISLAND RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3825
Practice Address - Country:US
Practice Address - Phone:410-266-9747
Practice Address - Fax:410-266-9749
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD188951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical