Healthcare Provider Details

I. General information

NPI: 1871826263
Provider Name (Legal Business Name): SHEREE NICOLE HALL LPC, NCC, MAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 GLENLAKE PARKWAY SUITE 130
ATLANTA GA
30328
US

IV. Provider business mailing address

PO BOX 733
DECATUR GA
30031
US

V. Phone/Fax

Practice location:
  • Phone: 678-358-4726
  • Fax: 678-974-2180
Mailing address:
  • Phone: 404-449-3696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number1597264
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC008117
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number254324
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number508999
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: