Provider Demographics
NPI:1609342880
Name:HAILEY, WANDA (LPCA)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:HAILEY
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 MASON RD
Mailing Address - Street 2:
Mailing Address - City:CLIMAX
Mailing Address - State:NC
Mailing Address - Zip Code:27233-9142
Mailing Address - Country:US
Mailing Address - Phone:336-628-4636
Mailing Address - Fax:336-521-9153
Practice Address - Street 1:215 FRIENDLY RD
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-8890
Practice Address - Country:US
Practice Address - Phone:336-628-4636
Practice Address - Fax:336-521-9153
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13240101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty