MEDICARE: HALEY COOPER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		NC

General Provider Information

NPI Number	:	1023960044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY COOPER

Provider Business Mailing Address
First Line	:	818 LAKE RD
Second Line	:
City	:	HERTFORD
State	:	NC
Zip	:	27944-8753
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 MEDICAL DR
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-3361
Country	:	US
Telephone Number	:	252-335-0803
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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Directions to “ HALEY COOPER ” Practice Location

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