Provider Demographics
NPI:1902553084
Name:HALLIWILL, CHARA LYNN (MSW)
Entity Type:Individual
Prefix:
First Name:CHARA
Middle Name:LYNN
Last Name:HALLIWILL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:CHARA
Other - Middle Name:LYNN
Other - Last Name:HAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1360 S HILLSDALE RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-9367
Mailing Address - Country:US
Mailing Address - Phone:517-439-2601
Mailing Address - Fax:517-439-2667
Practice Address - Street 1:1360 S HILLSDALE RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-9367
Practice Address - Country:US
Practice Address - Phone:517-439-2601
Practice Address - Fax:517-439-2667
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511143531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical