Healthcare Provider Details

I. General information

NPI: 1639403132
Provider Name (Legal Business Name): CRAIG MARSHALL HALES LCSW, LISW-CP, DCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JOHNSON HALL BUILDING X3973 URBAN FREEDOM PASS
FORT LIBERTY NC
28314
US

IV. Provider business mailing address

1209 ROBERTS ST
CAMDEN SC
29020-3735
US

V. Phone/Fax

Practice location:
  • Phone: 910-908-5330
  • Fax:
Mailing address:
  • Phone: 910-330-9204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW13009
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12162
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberC008532
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC008532
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801091106
License Number StateMI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: