Provider Demographics
NPI:1841366424
Name:SALTER-HAHULA, ALLISON NICHOLS (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:NICHOLS
Last Name:SALTER-HAHULA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ALLISON
Other - Middle Name:NICHOLS
Other - Last Name:SALTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:112 N CIRCLE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2430
Mailing Address - Country:US
Mailing Address - Phone:252-443-0272
Mailing Address - Fax:252-443-9101
Practice Address - Street 1:112 N CIRCLE DR
Practice Address - Street 2:SUITE B
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2430
Practice Address - Country:US
Practice Address - Phone:252-443-0272
Practice Address - Fax:252-443-9101
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0008261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC60-02110Medicaid
NC74312OtherBLUE CROSS BLUE SHIELD
NC74312OtherBLUE CROSS BLUE SHIELD