Provider Demographics
NPI:1275670531
Name:HALL, LACHEATA GRAVES (LPC-S)
Entity Type:Individual
Prefix:DR
First Name:LACHEATA
Middle Name:GRAVES
Last Name:HALL
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1262
Mailing Address - Street 2:
Mailing Address - City:YANCEYVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27379
Mailing Address - Country:US
Mailing Address - Phone:336-694-5922
Mailing Address - Fax:336-694-5920
Practice Address - Street 1:1220 MARSHALL GRAVES RD
Practice Address - Street 2:
Practice Address - City:YANCEYVILLE
Practice Address - State:NC
Practice Address - Zip Code:27379
Practice Address - Country:US
Practice Address - Phone:336-932-5242
Practice Address - Fax:336-694-5920
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2925101YP2500X
NCS2925101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102095Medicaid