Provider Demographics
NPI:1609974526
Name:HAILEY, MEREDITH LEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:LEE
Last Name:HAILEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 W NC HIGHWAY 54
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5571
Mailing Address - Country:US
Mailing Address - Phone:919-403-2122
Mailing Address - Fax:919-401-4993
Practice Address - Street 1:120 CAPCOM AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587
Practice Address - Country:US
Practice Address - Phone:919-488-1444
Practice Address - Fax:919-488-1445
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0023541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2873509BMedicare ID - Type Unspecified
NC6002864Medicare ID - Type Unspecified