Provider Demographics
NPI:1679126759
Name:HALL, CARMEN JOHNSON (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:JOHNSON
Last Name:HALL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 HYDE DR APT J
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-8056
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2416 BEDGOOD DR SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-8515
Practice Address - Country:US
Practice Address - Phone:252-265-9200
Practice Address - Fax:252-237-8600
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0144151041C0700X
NCP0127141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical