Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | PC009370 | PA |
NPI | 1003354291 |
---|---|
Provider Name | Marlynn Rae Hall |
First Address | Philadelphia, PA 19147-5948 |
Second Address | Philadelphia, PA 19147-5948 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2017 |
Last Update Date | 10/02/2021 |