Provider Demographics
NPI:1336468255
Name:HALL, CHARLTON BRUCE
Entity Type:Individual
Prefix:MR
First Name:CHARLTON
Middle Name:BRUCE
Last Name:HALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHUCK
Other - Middle Name:
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29635-0102
Mailing Address - Country:US
Mailing Address - Phone:864-384-2388
Mailing Address - Fax:
Practice Address - Street 1:12 PELHAM RD
Practice Address - Street 2:SUITE B
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-2142
Practice Address - Country:US
Practice Address - Phone:864-384-2388
Practice Address - Fax:888-525-5318
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2017-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1306106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist