Provider Demographics
NPI:1801036694
Name:HALLIE, LOUIE GABRIELE (LICSW)
Entity Type:Individual
Prefix:MR
First Name:LOUIE
Middle Name:GABRIELE
Last Name:HALLIE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 N. 30TH ST.
Mailing Address - Street 2:SUITE B
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403
Mailing Address - Country:US
Mailing Address - Phone:253-272-5059
Mailing Address - Fax:
Practice Address - Street 1:2205 N. 30TH ST.
Practice Address - Street 2:SUITE B
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403
Practice Address - Country:US
Practice Address - Phone:253-272-5059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000053151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical