Provider Demographics
NPI:1760742597
Name:HALO CENTER OF WELLNESS, PA
Entity Type:Organization
Organization Name:HALO CENTER OF WELLNESS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:COLDIRON
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, EDS, LPCS
Authorized Official - Phone:336-207-6649
Mailing Address - Street 1:883 NC HIGHWAY 88 E
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640-9319
Mailing Address - Country:US
Mailing Address - Phone:336-207-6649
Mailing Address - Fax:
Practice Address - Street 1:883 NC HIGHWAY 88 E
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640-9319
Practice Address - Country:US
Practice Address - Phone:336-207-6649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-27
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7207101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty