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 1:2375 MAIN ST NW APT 408
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-2914
Mailing Address - Country:US
Mailing Address - Phone:716-465-1108
Mailing Address - Fax:
Practice Address - Street 1:2375 MAIN ST NW APT 408
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-2914
Practice Address - Country:US
Practice Address - Phone:716-465-1108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1707101YA0400X
VA0701006204101YM0800X, 101YP2500X
NC9378101YP2500X
GA008039101YP2500X
MDLCPC7200101YP2500X
DCPRC15050101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health