Healthcare Provider Details

I. General information

NPI: 1164111985
Provider Name (Legal Business Name): HALEY PEGRAM QUICK LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 03/21/2026
Certification Date: 03/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6614 SHALLOWFORD RD
LEWISVILLE NC
27023-9303
US

IV. Provider business mailing address

5126 WALLBURG RD
WINSTON SALEM NC
27107-9598
US

V. Phone/Fax

Practice location:
  • Phone: 336-934-5519
  • Fax:
Mailing address:
  • Phone: 336-682-1474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17934
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number17934
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: