Provider Demographics
NPI:1861292609
Name:HALE, CARMELITA (LPC)
Entity type:Individual
Prefix:
First Name:CARMELITA
Middle Name:
Last Name:HALE
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 BAILEY DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-7125
Mailing Address - Country:US
Mailing Address - Phone:484-797-9386
Mailing Address - Fax:
Practice Address - Street 1:521 SHUGA BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-1204
Practice Address - Country:US
Practice Address - Phone:706-431-5357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC015592101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health