Provider Demographics
NPI:1376996181
Name:HALLORAN, CHARLES STUART (LPC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:STUART
Last Name:HALLORAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 W 44TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4622
Mailing Address - Country:US
Mailing Address - Phone:804-839-9923
Mailing Address - Fax:
Practice Address - Street 1:811 W 44TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4622
Practice Address - Country:US
Practice Address - Phone:804-839-9923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-16
Last Update Date:2016-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005939101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional