Healthcare Provider Details

I. General information

NPI: 1326956319
Provider Name (Legal Business Name): KACIE LOU ELIZABETH HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 CREWS RD STE H
MATTHEWS NC
28105-7586
US

IV. Provider business mailing address

4243 CENTRAL GREEN LN UNIT 9308
CHARLOTTE NC
28262-1975
US

V. Phone/Fax

Practice location:
  • Phone: 980-758-0017
  • Fax:
Mailing address:
  • Phone: 803-487-5959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP024389
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: