Provider Demographics
NPI:1316303415
Name:HALL, TAMRA S (LCSW)
Entity type:Individual
Prefix:MS
First Name:TAMRA
Middle Name:S
Last Name:HALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 870006
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30287-0006
Mailing Address - Country:US
Mailing Address - Phone:770-961-1997
Mailing Address - Fax:770-961-1985
Practice Address - Street 1:1607 LAKE HARBIN RD
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-1721
Practice Address - Country:US
Practice Address - Phone:770-961-1997
Practice Address - Fax:770-961-1985
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0046101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical