Provider Demographics
NPI:1689949091
Name:SALLEY, LORA MICHELLE (LPC)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:MICHELLE
Last Name:SALLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 COLLEGE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697-2700
Mailing Address - Country:US
Mailing Address - Phone:336-818-0733
Mailing Address - Fax:336-818-0734
Practice Address - Street 1:1260 COLLEGE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-2700
Practice Address - Country:US
Practice Address - Phone:336-818-0733
Practice Address - Fax:336-818-0734
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8970101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional