Provider Demographics
NPI:1699945402
Name:MCLEOD, HALLIE ANN (MA)
Entity type:Individual
Prefix:
First Name:HALLIE
Middle Name:ANN
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 CONSTITUTION DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554
Mailing Address - Country:US
Mailing Address - Phone:304-669-6408
Mailing Address - Fax:304-636-9243
Practice Address - Street 1:1907 CONSTITUTION DRIVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554
Practice Address - Country:US
Practice Address - Phone:304-669-6408
Practice Address - Fax:304-636-9243
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV94-306101YA0400X
WV1363101YP2500X
WV756103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional