Provider Demographics
NPI:1558055343
Name:HANEY, SHELLEY WILCOX
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:WILCOX
Last Name:HANEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 VALDESE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-2905
Mailing Address - Country:US
Mailing Address - Phone:828-608-0867
Mailing Address - Fax:828-608-0951
Practice Address - Street 1:210 VALDESE AVE STE A
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-2905
Practice Address - Country:US
Practice Address - Phone:828-608-0867
Practice Address - Fax:828-608-0951
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
16533101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral