Healthcare Provider Details

I. General information

NPI: 1932613866
Provider Name (Legal Business Name): JASON HALLMAN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418A BARR RD
LEXINGTON SC
29072-2363
US

IV. Provider business mailing address

335 PINE ST NW
SALLEY SC
29137-9787
US

V. Phone/Fax

Practice location:
  • Phone: 803-674-4060
  • Fax:
Mailing address:
  • Phone: 803-240-6224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7345
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: