Provider Demographics
NPI:1417218553
Name:HALE, TAMARA L (LPC)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:L
Last Name:HALE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:
Other - Last Name:REEDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:1769 JAMESTOWN RD STE 207
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-2307
Mailing Address - Country:US
Mailing Address - Phone:208-912-0292
Mailing Address - Fax:208-912-0299
Practice Address - Street 1:1769 JAMESTOWN RD STE 207
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2307
Practice Address - Country:US
Practice Address - Phone:208-912-0292
Practice Address - Fax:208-912-0299
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-5858101YP2500X
VA0701007258101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDLPC-4966OtherSTATE OF IDAHO OCCUPATIONAL LICENSE