Healthcare Provider Details

I. General information

NPI: 1780384578
Provider Name (Legal Business Name): KAREN ANNE HALLING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 BIZ LN
YEMASSEE SC
29945-7715
US

IV. Provider business mailing address

37 BIZ LN
YEMASSEE SC
29945-7715
US

V. Phone/Fax

Practice location:
  • Phone: 843-489-1265
  • Fax:
Mailing address:
  • Phone: 843-489-1265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6370
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: