Provider Demographics
NPI:1003489907
Name:SLATE, HALEY LYNN (MS, LCMHC, NCC)
Entity Type:Individual
Prefix:MS
First Name:HALEY
Middle Name:LYNN
Last Name:SLATE
Suffix:
Gender:F
Credentials:MS, LCMHC, NCC
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:LYNN
Other - Last Name:PENK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LCMHCA, NCC
Mailing Address - Street 1:128 TATE ST APT B
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1837
Mailing Address - Country:US
Mailing Address - Phone:704-918-0899
Mailing Address - Fax:
Practice Address - Street 1:1205 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5762
Practice Address - Country:US
Practice Address - Phone:336-901-2998
Practice Address - Fax:336-513-0554
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16722101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health