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NPI Code Detail

MEDICARE: HALEY JACKSON MS, LMHC, LCMHC

MEDICARE: HALEY JACKSON MS, LMHC, LCMHC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor014125NY
2101YM0800XMental Health Counselor20182NC

General Provider Information

NPI Number : 1548936784
Entity Type Code : Individual
Provider Name (Legal Business Name) : HALEY JACKSON MS, LMHC, LCMHC
Provider Business Mailing Address
First Line : 7400 CARMEL EXECUTIVE PARK DR
Second Line : SUITE 155
City : CHARLOTTE
State : NC
Zip : 28226-8242
Country : US
Telephone Number : 828-350-1177
Fax Number :
Provider Business Practice Location Address
First Line : 7400 CARMEL EXECUTIVE PARK DR
Second Line : SUITE 155
City : CHARLOTTE
State : NC
Zip : 28226-8242
Country : US
Telephone Number : 828-350-1177
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2021
Last Update Date : 10/07/2024

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