Provider Demographics
NPI:1063762243
Name:HALL, KRYSTAL (LCAS, LPC)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:LCAS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312B SADLER DR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-9868
Mailing Address - Country:US
Mailing Address - Phone:919-922-7924
Mailing Address - Fax:
Practice Address - Street 1:313 CLIFTON ST STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5008
Practice Address - Country:US
Practice Address - Phone:252-966-9010
Practice Address - Fax:252-966-9016
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10548101YM0800X, 101YP2500X
NC2907101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)