Provider Demographics
NPI:1821320664
Name:HALEY, FREDERICA (LPA)
Entity Type:Individual
Prefix:
First Name:FREDERICA
Middle Name:
Last Name:HALEY
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 E GREEN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-3423
Mailing Address - Country:US
Mailing Address - Phone:910-817-9181
Mailing Address - Fax:833-909-9090
Practice Address - Street 1:304 E GREEN ST
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-3423
Practice Address - Country:US
Practice Address - Phone:910-817-9181
Practice Address - Fax:833-909-9090
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1569103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107343Medicaid