Provider Demographics
NPI:1942514658
Name:HALL, TARA LEIGH (MA, CAC, LPC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LEIGH
Last Name:HALL
Suffix:
Gender:F
Credentials:MA, CAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 PHOENIX DR
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4534
Mailing Address - Country:US
Mailing Address - Phone:717-261-9100
Mailing Address - Fax:717-261-9104
Practice Address - Street 1:455 PHOENIX DR
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4534
Practice Address - Country:US
Practice Address - Phone:717-261-9100
Practice Address - Fax:717-261-9104
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA005566101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional