Provider Demographics
NPI:1245382779
Name:HALLY, ELOISE (LCSW)
Entity type:Individual
Prefix:
First Name:ELOISE
Middle Name:
Last Name:HALLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELOISE
Other - Middle Name:HALLY
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16A LENOX POINTE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324
Mailing Address - Country:US
Mailing Address - Phone:404-467-9456
Mailing Address - Fax:888-709-1716
Practice Address - Street 1:16A LENOX POINTE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324
Practice Address - Country:US
Practice Address - Phone:404-467-9456
Practice Address - Fax:888-709-1716
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0032761041C0700X
101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral