Individual
DOMINICK HALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
733 KEYSER AVE STE 120, NATCHITOCHES, LA 71457-0039
(318) 238-4030
(318) 787-5768
Mailing address
733 KEYSER AVE STE 120, NATCHITOCHES, LA 71457-0039
(318) 238-4030
(318) 787-5768
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1544761
—
LA
01
—
1679507412
OTHER
LA
Enumeration date
08/31/2016
Last updated
01/17/2024
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