Healthcare Provider Details

I. General information

NPI: 1134723588
Provider Name (Legal Business Name): CATHERINE J. HALL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 WINDSOR RUN LN
MATTHEWS NC
28105-0054
US

IV. Provider business mailing address

5730 EXECUTIVE DR STE 230
CATONSVILLE MD
21228-1762
US

V. Phone/Fax

Practice location:
  • Phone: 704-443-6250
  • Fax: 704-443-6279
Mailing address:
  • Phone: 410-402-2379
  • Fax: 410-469-3085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC007300
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: