Provider Demographics
NPI:1275904187
Name:HAILE, ALEXIS A (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:A
Last Name:HAILE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:A
Other - Last Name:SANTARELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:SHAMOKIN
Mailing Address - State:PA
Mailing Address - Zip Code:17872-7551
Mailing Address - Country:US
Mailing Address - Phone:570-339-1828
Mailing Address - Fax:570-339-1924
Practice Address - Street 1:129 E 5TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:PA
Practice Address - Zip Code:17851-2175
Practice Address - Country:US
Practice Address - Phone:570-339-1828
Practice Address - Fax:570-339-1924
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PC008353101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health