Healthcare Provider Details

I. General information

NPI: 1306710017
Provider Name (Legal Business Name): MARSHA HALEY WYLAND LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5330 RAEFORD RD
FAYETTEVILLE NC
28304-3074
US

IV. Provider business mailing address

5330 RAEFORD RD
FAYETTEVILLE NC
28304-3074
US

V. Phone/Fax

Practice location:
  • Phone: 910-222-3681
  • Fax:
Mailing address:
  • Phone: 910-217-6501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22080
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: