Provider Demographics
NPI:1447311667
Name:HALLY, CAROLYN R (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:R
Last Name:HALLY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 RIVERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-4631
Mailing Address - Country:US
Mailing Address - Phone:706-543-5155
Mailing Address - Fax:706-543-6576
Practice Address - Street 1:323 RIVERVIEW RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-4631
Practice Address - Country:US
Practice Address - Phone:706-543-5155
Practice Address - Fax:706-543-6576
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001338103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling