Provider Demographics
NPI:1780455519
Name:GILES, HALEY (LCMHCA)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:GILES
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 FORSYTHE ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3765
Mailing Address - Country:US
Mailing Address - Phone:910-750-2048
Mailing Address - Fax:
Practice Address - Street 1:2931 BREEZEWOOD AVE STE 104
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5281
Practice Address - Country:US
Practice Address - Phone:910-491-1134
Practice Address - Fax:910-491-1332
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19545101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty