Provider Demographics
NPI:1568841732
Name:HALL, ANGELA DENISE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DENISE
Last Name:HALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 PRYOR ST SW
Mailing Address - Street 2:SUITE 2128
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-2713
Mailing Address - Country:US
Mailing Address - Phone:404-613-4637
Mailing Address - Fax:
Practice Address - Street 1:395 PRYOR ST SW
Practice Address - Street 2:SUITE 2128
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-2713
Practice Address - Country:US
Practice Address - Phone:404-613-4637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0022781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical