Provider Demographics
NPI:1841398906
Name:HALES, MARY G (MA,LCAS, LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:G
Last Name:HALES
Suffix:
Gender:F
Credentials:MA,LCAS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10696 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-4411
Mailing Address - Country:US
Mailing Address - Phone:571-239-5771
Mailing Address - Fax:
Practice Address - Street 1:10696 CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-4411
Practice Address - Country:US
Practice Address - Phone:571-239-5771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9378101YP2500X
NC1707101YA0400X
VA0701006204101YP2500X
GA008039101YP2500X
MDLCPC7200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)