Provider Demographics
NPI:1326873191
Name:HUFFINES, CALAH BROOKE FAIRCLOTH (MA, LCMHCA)
Entity type:Individual
Prefix:
First Name:CALAH
Middle Name:BROOKE FAIRCLOTH
Last Name:HUFFINES
Suffix:
Gender:F
Credentials:MA, LCMHCA
Other - Prefix:
Other - First Name:CALAH
Other - Middle Name:BROOKE
Other - Last Name:FAIRCLOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2487 SOMERSET PLACE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-9624
Mailing Address - Country:US
Mailing Address - Phone:828-514-9095
Mailing Address - Fax:
Practice Address - Street 1:860 W 5TH ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-2506
Practice Address - Country:US
Practice Address - Phone:336-355-8244
Practice Address - Fax:336-546-7630
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20479101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor