Provider Demographics
NPI:1386777662
Name:HALKER, PETRA MEREDITH (LCSW)
Entity type:Individual
Prefix:MRS
First Name:PETRA
Middle Name:MEREDITH
Last Name:HALKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 SHADY GROVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-9665
Mailing Address - Country:US
Mailing Address - Phone:336-769-4734
Mailing Address - Fax:336-769-4497
Practice Address - Street 1:232 N EDGEWORTH ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2218
Practice Address - Country:US
Practice Address - Phone:336-641-4338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0009411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical