Provider Demographics
NPI:1386449486
Name:HALE, CARMEN VERNEESE
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:VERNEESE
Last Name:HALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 DOMINGUES AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIANVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35759-3801
Mailing Address - Country:US
Mailing Address - Phone:256-658-4113
Mailing Address - Fax:
Practice Address - Street 1:3407 TRIANA BLVD SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-4641
Practice Address - Country:US
Practice Address - Phone:833-747-4222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician