Healthcare Provider Details

I. General information

NPI: 1477482784
Provider Name (Legal Business Name): HALLE WALCOTT LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 JOURNAL SQ STE 505
JERSEY CITY NJ
07306-4105
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 732-982-2888
  • Fax:
Mailing address:
  • Phone: 732-982-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37AC00838700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number32WC01352400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: