Provider Demographics
NPI:1669803060
Name:HALL, TANJELA S
Entity type:Individual
Prefix:MRS
First Name:TANJELA
Middle Name:S
Last Name:HALL
Suffix:
Gender:F
Credentials:
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 563305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28256-3305
Mailing Address - Country:US
Mailing Address - Phone:704-615-8827
Mailing Address - Fax:704-599-8760
Practice Address - Street 1:301 MCCULLOUGH DR STE 400
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1336
Practice Address - Country:US
Practice Address - Phone:704-615-8827
Practice Address - Fax:704-599-8760
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13823101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor