Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | ||
Y | 1041C0700X | Clinical Social Worker | CSW003276 | GA |
NPI | 1245382779 |
---|---|
Provider Name | Eloise Hally |
First Address | Atlanta, GA 30324 |
Second Address | Atlanta, GA 30324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 28/01/2010 |