Provider Demographics
NPI:1306506498
Name:LANDRY, HALEY L (MA, LCMHCA)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:L
Last Name:LANDRY
Suffix:
Gender:F
Credentials:MA, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7415 DICKINBEN DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27358-9516
Mailing Address - Country:US
Mailing Address - Phone:704-860-5375
Mailing Address - Fax:
Practice Address - Street 1:1180 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-9856
Practice Address - Country:US
Practice Address - Phone:336-283-3830
Practice Address - Fax:336-283-3827
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17139101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health