Provider Demographics
NPI:1487849071
Name:HALE, JOSEPH THEODORE IV (LPC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:THEODORE
Last Name:HALE
Suffix:IV
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 COUNTRY CLUB RD
Mailing Address - Street 2:210
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-4241
Mailing Address - Country:US
Mailing Address - Phone:336-499-1244
Mailing Address - Fax:
Practice Address - Street 1:4010 IVY BLUFF TRL
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-2584
Practice Address - Country:US
Practice Address - Phone:336-922-6349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC817101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional