Basic Information
| Provider Information | |||||||||
| NPI: | 1679126759 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | CARMEN | ||||||||
| MiddleName: | JOHNSON | ||||||||
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| Credential: | MSW, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1990 HYDE DR APT J | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278588056 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2416 BEDGOOD DR SW | ||||||||
| Address2: | |||||||||
| City: | WILSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278938515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522659200 | ||||||||
| FaxNumber: | 2522378600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2019 | ||||||||
| LastUpdateDate: | 08/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C014415 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | P012714 | NC | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.