Healthcare Provider Details

I. General information

NPI: 1245382779
Provider Name (Legal Business Name): ELOISE HALLY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELOISE HALLY SMITH

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 01/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16A LENOX POINTE NE
ATLANTA GA
30324
US

IV. Provider business mailing address

16A LENOX POINTE NE
ATLANTA GA
30324
US

V. Phone/Fax

Practice location:
  • Phone: 404-467-9456
  • Fax: 888-709-1716
Mailing address:
  • Phone: 404-467-9456
  • Fax: 888-709-1716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW003276
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: