Provider Demographics
NPI:1891819330
Name:HALL, GEORGE TIMOTHY (MDIV,LCAS,CCS)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:TIMOTHY
Last Name:HALL
Suffix:
Gender:M
Credentials:MDIV,LCAS,CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 MEADOW VIEW RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-1920
Mailing Address - Country:US
Mailing Address - Phone:910-618-9912
Mailing Address - Fax:910-618-0728
Practice Address - Street 1:3750 MEADOW VIEW RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-1920
Practice Address - Country:US
Practice Address - Phone:910-618-9912
Practice Address - Fax:910-618-0728
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6110549Medicaid