Provider Demographics
NPI:1598330029
Name:HALLA, KATHARINE
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:HALLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 ARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:PORT DEPOSIT
Mailing Address - State:MD
Mailing Address - Zip Code:21904-1238
Mailing Address - Country:US
Mailing Address - Phone:484-356-8555
Mailing Address - Fax:
Practice Address - Street 1:221 ARTHUR AVE
Practice Address - Street 2:
Practice Address - City:PORT DEPOSIT
Practice Address - State:MD
Practice Address - Zip Code:21904-1238
Practice Address - Country:US
Practice Address - Phone:443-502-0399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9952101YP2500X
MDLC12827101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional