Healthcare Provider Details

I. General information

NPI: 1407586324
Provider Name (Legal Business Name): COURTNEY SI'ERRA HALL MSW, LCSWA, CD(DONA)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: COURTNEY SI'ERRA HALL MSW, LCSWA

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 MARTIN LUTHER KING JR DR UNIT B
GREENSBORO NC
27406-1620
US

IV. Provider business mailing address

1907 BUCKMINSTER DR
WHITSETT NC
27377-9335
US

V. Phone/Fax

Practice location:
  • Phone: 336-638-1907
  • Fax:
Mailing address:
  • Phone: 336-255-6858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP015934
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number1115425
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number12859
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: