Provider Demographics
NPI:1225695166
Name:HALL, CHARLES (MSW, LGSW, LCADC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:HALL
Suffix:
Gender:M
Credentials:MSW, LGSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 LIBERTY PKWY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21222-3950
Mailing Address - Country:US
Mailing Address - Phone:410-285-1506
Mailing Address - Fax:
Practice Address - Street 1:1201 CAMBRIA ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-2223
Practice Address - Country:US
Practice Address - Phone:410-396-1373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA246101YA0400X
MDG082731041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)