Provider Demographics
NPI:1568714343
Name:HALEY, ANGELA L (LCPC-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:L
Last Name:HALEY
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:L
Other - Last Name:CONRAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 MAIN ST.
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6359
Mailing Address - Country:US
Mailing Address - Phone:207-941-8727
Mailing Address - Fax:207-992-2784
Practice Address - Street 1:21 MAIN ST.
Practice Address - Street 2:SUITE 301
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6359
Practice Address - Country:US
Practice Address - Phone:207-941-8727
Practice Address - Fax:207-992-2784
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3687101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional