Provider Demographics
NPI:1780926162
Name:HALL, JEROME (LCSW, LCAS-A)
Entity type:Individual
Prefix:MR
First Name:JEROME
Middle Name:
Last Name:HALL
Suffix:
Gender:M
Credentials:LCSW, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7223 DOVE FIELD DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29707-7846
Mailing Address - Country:US
Mailing Address - Phone:704-771-2976
Mailing Address - Fax:843-456-2063
Practice Address - Street 1:7223 DOVE FIELD DR
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29707-7846
Practice Address - Country:US
Practice Address - Phone:803-431-7100
Practice Address - Fax:843-456-0263
Is Sole Proprietor?:No
Enumeration Date:2013-03-23
Last Update Date:2022-08-23
Deactivation Date:2022-07-26
Deactivation Code:
Reactivation Date:2022-08-23
Provider Licenses
StateLicense IDTaxonomies
NC3081-A101YA0400X
NCC0102891041C0700X
SC96391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)