Healthcare Provider Details

I. General information

NPI: 1679952501
Provider Name (Legal Business Name): HALLIE ANN HUFFMAN LCSW, LCAS, CCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 WAKE FOREST RD STE 349
RALEIGH NC
27609-0010
US

IV. Provider business mailing address

2127 RIVERGRASS CT
RALEIGH NC
27610-5355
US

V. Phone/Fax

Practice location:
  • Phone: 704-996-7265
  • Fax:
Mailing address:
  • Phone: 704-996-7265
  • Fax: 910-897-2009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-21193
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW-C011026
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: