Healthcare Provider Details

I. General information

NPI: 1194171439
Provider Name (Legal Business Name): HALLIE SYLVESTRO LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 05/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E WASHINGTON ST
GREENSBORO NC
27401-2911
US

IV. Provider business mailing address

902 BONNER DR
JAMESTOWN NC
27282-8948
US

V. Phone/Fax

Practice location:
  • Phone: 336-889-6105
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA11017
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: