Provider Demographics
NPI:1467916171
Name:HALE, TANDY LIN (LPC, ATR)
Entity Type:Individual
Prefix:
First Name:TANDY
Middle Name:LIN
Last Name:HALE
Suffix:
Gender:F
Credentials:LPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:TRENT WOODS
Mailing Address - State:NC
Mailing Address - Zip Code:28562-7461
Mailing Address - Country:US
Mailing Address - Phone:252-259-0468
Mailing Address - Fax:
Practice Address - Street 1:1917 TRENT BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-4537
Practice Address - Country:US
Practice Address - Phone:252-631-5337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-27
Last Update Date:2019-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17-094221700000X
NC12064101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist