Provider Demographics
NPI:1952041865
Name:DR. LISA HALL, LCSW
Entity Type:Organization
Organization Name:DR. LISA HALL, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW, MSP, MPA
Authorized Official - Phone:678-517-9984
Mailing Address - Street 1:PO BOX 652
Mailing Address - Street 2:
Mailing Address - City:AVONDALE ESTATES
Mailing Address - State:GA
Mailing Address - Zip Code:30002-0652
Mailing Address - Country:US
Mailing Address - Phone:678-517-9984
Mailing Address - Fax:404-292-9424
Practice Address - Street 1:3500 COVINGTON HWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032
Practice Address - Country:US
Practice Address - Phone:678-517-9984
Practice Address - Fax:404-292-9424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-30
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health