MEDICARE: MRS. ALLISON NICHOLS SALTER-HAHULA LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C000826	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	74312	OTHER	NC	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1841366424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALLISON NICHOLS SALTER-HAHULA LCSW

Provider Business Mailing Address
First Line	:	112 N CIRCLE DR
Second Line	:	SUITE B
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-2430
Country	:	US
Telephone Number	:	252-443-0272
Fax Number	:	252-443-9101

Provider Business Practice Location Address
First Line	:	112 N CIRCLE DR
Second Line	:	SUITE B
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-2430
Country	:	US
Telephone Number	:	252-443-0272
Fax Number	:	252-443-9101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	11/25/2009

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