1467543116 NPI number — TYRINDA C. HALL SOCIAL WORKER, LICSW

Table of content: TYRINDA C. HALL SOCIAL WORKER, LICSW (NPI 1467543116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467543116 NPI number — TYRINDA C. HALL SOCIAL WORKER, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALL
Provider First Name:
TYRINDA
Provider Middle Name:
C.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SOCIAL WORKER, LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HALL
Provider Other First Name:
TYRINDA
Provider Other Middle Name:
C.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICSW-PIP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1467543116
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 640692
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIKE ROAD
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36064-0692
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-413-7773
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 HOSPITAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSKEGEE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36083-5001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-727-0550
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  2373C , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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