Provider Demographics
NPI:1871826263
Name:HALL, SHEREE NICOLE (LPC, NCC, MAC)
Entity Type:Individual
Prefix:MISS
First Name:SHEREE
Middle Name:NICOLE
Last Name:HALL
Suffix:
Gender:F
Credentials:LPC, NCC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 733
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30031
Mailing Address - Country:US
Mailing Address - Phone:404-449-3696
Mailing Address - Fax:
Practice Address - Street 1:10 GLENLAKE PARKWAY
Practice Address - Street 2:SUITE 130
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:678-358-4726
Practice Address - Fax:678-974-2180
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1597264101YS0200X
GALPC008117101YM0800X
NC254324101Y00000X
VA508999101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)