Healthcare Provider Details

I. General information

NPI: 1679126759
Provider Name (Legal Business Name): CARMEN JOHNSON HALL MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 BEDGOOD DR SW
WILSON NC
27893-8515
US

IV. Provider business mailing address

1990 HYDE DR APT J
GREENVILLE NC
27858-8056
US

V. Phone/Fax

Practice location:
  • Phone: 252-265-9200
  • Fax: 252-237-8600
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC014415
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP012714
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: