Provider Demographics
NPI:1235142670
Name:HALL, TERESA ANN (LCSW)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:HALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4000
Mailing Address - Street 2:SOCIAL WORK (122)
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684-4000
Mailing Address - Country:US
Mailing Address - Phone:423-979-2647
Mailing Address - Fax:423-979-2720
Practice Address - Street 1:53 MEMORIAL DR
Practice Address - Street 2:JAMES H. QUILLEN VAMC, SOCIAL WORK (122)
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684-5000
Practice Address - Country:US
Practice Address - Phone:423-979-2647
Practice Address - Fax:423-979-2720
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0054071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical