Individual
DERIC ANTOINE HALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
20443 AUTUMN FERN AVE, TAMPA, FL 33647-2967
(727) 479-5842
Mailing address
20443 AUTUMN FERN AVE, TAMPA, FL 33647-2967
(727) 479-5842
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
IMT3706
FL
Other
Enumeration date
06/21/2023
Last updated
06/21/2023
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