Provider Demographics
NPI:1679179832
Name:HALL, NATHAN (RBT)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:HALL
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 LANDINGS LN APT 21
Mailing Address - Street 2:
Mailing Address - City:WEYERS CAVE
Mailing Address - State:VA
Mailing Address - Zip Code:24486-0019
Mailing Address - Country:US
Mailing Address - Phone:413-358-7031
Mailing Address - Fax:
Practice Address - Street 1:32 LANDINGS LN APT 21
Practice Address - Street 2:
Practice Address - City:WEYERS CAVE
Practice Address - State:VA
Practice Address - Zip Code:24486-0019
Practice Address - Country:US
Practice Address - Phone:413-358-7031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician