Provider Demographics
NPI:1396178562
Name:HALL, CAROLINE LOWRY (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:LOWRY
Last Name:HALL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4467 CASCADE RD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3776
Mailing Address - Country:US
Mailing Address - Phone:616-818-6678
Mailing Address - Fax:616-956-3020
Practice Address - Street 1:4467 CASCADE RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3776
Practice Address - Country:US
Practice Address - Phone:616-690-7319
Practice Address - Fax:616-956-3020
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2534798101YP2500X
MICC-WYW950030016101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool