Provider Demographics
NPI:1093919649
Name:HALL, CAROLYN CASSANDRA (ASSOCIATE DEGREE BA)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:CASSANDRA
Last Name:HALL
Suffix:
Gender:F
Credentials:ASSOCIATE DEGREE BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 HALL SIDING RD
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-8095
Mailing Address - Country:US
Mailing Address - Phone:252-332-4333
Mailing Address - Fax:
Practice Address - Street 1:203 HALL SIDING RD
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-8095
Practice Address - Country:US
Practice Address - Phone:252-332-4333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health