Provider Demographics
NPI:1619359478
Name:HALL, TERRESA (LCSW-A)
Entity Type:Individual
Prefix:
First Name:TERRESA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 ROANOKE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-2740
Mailing Address - Country:US
Mailing Address - Phone:252-308-1247
Mailing Address - Fax:252-308-1248
Practice Address - Street 1:622 ROANOKE AVE STE A
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-2740
Practice Address - Country:US
Practice Address - Phone:252-308-1247
Practice Address - Fax:252-308-1248
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC90098371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical