Healthcare Provider Details

I. General information

NPI: 1497958847
Provider Name (Legal Business Name): SANDRA HALE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CENTURY PL NE SUITE 200
ATLANTA GA
30345-4307
US

IV. Provider business mailing address

1383 WOODLAND HILLS DR NE
ATLANTA GA
30324-4630
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-4954
  • Fax: 404-321-1928
Mailing address:
  • Phone: 404-321-4954
  • Fax: 404-321-1928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC004062
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: