Provider Demographics
NPI:1164111985
Name:QUICK, HALEY PEGRAM (LCMHCA)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:PEGRAM
Last Name:QUICK
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5126 WALLBURG RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-9598
Mailing Address - Country:US
Mailing Address - Phone:336-682-1474
Mailing Address - Fax:
Practice Address - Street 1:2554 LEWISVILLE CLEMMONS RD STE 112
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-9927
Practice Address - Country:US
Practice Address - Phone:336-283-2510
Practice Address - Fax:336-776-0091
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17934101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1164111985Medicaid