Healthcare Provider Details

I. General information

NPI: 1194342378
Provider Name (Legal Business Name): CHRISTINA HALL VIDEON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2020
Last Update Date: 07/03/2020
Certification Date: 07/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 HUDSON TRCE STE 100
AUGUSTA GA
30907-2010
US

IV. Provider business mailing address

207 HUDSON TRCE STE 100
AUGUSTA GA
30907-2010
US

V. Phone/Fax

Practice location:
  • Phone: 706-823-5250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: