Provider Demographics
NPI:1164536090
Name:HILAIRE, SALA IMARA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SALA
Middle Name:IMARA
Last Name:HILAIRE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SALA
Other - Middle Name:AMINAH
Other - Last Name:IMARA BELLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4560 ORKNEY LN SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-7438
Mailing Address - Country:US
Mailing Address - Phone:678-772-4952
Mailing Address - Fax:
Practice Address - Street 1:4560 ORKNEY LN SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-7438
Practice Address - Country:US
Practice Address - Phone:678-772-4952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0019801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBFTQMedicaid
GA80BBFTQMedicaid
GA931359420AMedicare ID - Type Unspecified