MEDICARE: MRS. HOPE J HAILEY LPC

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	101YP2500X	Professional Counselor	LPC008446	GA

General Provider Information

NPI Number	:	1568838258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOPE J HAILEY LPC

Provider Business Mailing Address
First Line	:	850 OLD CREEK TRL
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-3615
Country	:	US
Telephone Number	:	678-772-3687
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 OLD CREEK TRL
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-3615
Country	:	US
Telephone Number	:	678-772-3687
Fax Number	:

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

Provider Enumeration Date	:	08/17/2015
Last Update Date	:	08/17/2015

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