Provider Demographics
NPI:1205998051
Name:HALL, PATRICIA A (EDS)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:HALL
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 SUMTER ST
Mailing Address - Street 2:PALMETTO HEALTH COUNSELING
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2829
Mailing Address - Country:US
Mailing Address - Phone:803-296-5879
Mailing Address - Fax:803-296-5061
Practice Address - Street 1:1501 SUMTER ST
Practice Address - Street 2:PALMETTO HEALTH COUNSELING
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2829
Practice Address - Country:US
Practice Address - Phone:803-296-5879
Practice Address - Fax:803-296-5061
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4796101YP2500X
SC4506106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4506OtherLICENSE MARRIAGE AND FAMILY THERAPIST