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General NPI Number Information
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NPI Number | 1316670482
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Entity Type | Individual
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Provider Name | HAILEY KROUSE PEREZ PHD
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Gender | Female
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Dates
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Enumeration Date | 07/06/2022
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Last Update Date | 07/06/2022
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Provider Practice Location Address
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Address Line | 3624 NORMAN BLALOCK RD
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City | WILLOW SPRING
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State | NC
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Zip | 27592-8966
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Country | US
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Telephone | 919-903-6209
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Fax |
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Provider Business Mailing Address
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Address Line | 6805 DWIGHT ROWLAND RD UNIT 621
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City | WILLOW SPRING
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State | NC
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Zip | 27592-0150
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Country | US
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Telephone | 919-704-4204
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 4777
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License Number State | NC
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