Provider Demographics
NPI:1740418185
Name:HALL, TERESA S (MS,CAMF)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:S
Last Name:HALL
Suffix:
Gender:F
Credentials:MS,CAMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4746 GERTRUDE DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-5750
Mailing Address - Country:US
Mailing Address - Phone:901-283-8968
Mailing Address - Fax:901-757-2778
Practice Address - Street 1:4746 GERTRUDE DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-5750
Practice Address - Country:US
Practice Address - Phone:901-283-8968
Practice Address - Fax:901-757-2778
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN104006275101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor