Individual
MS. HALLIE CORNELIA THAXTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
389 HOMEPLACE RD, RUSTBURG, VA 24588-3792
(434) 942-2298
(434) 616-2377
Mailing address
389 HOMEPLACE RD, RUSTBURG, VA 24588-3792
(434) 942-2298
(434) 616-2377
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
08/09/2023
Last updated
08/09/2023
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