MEDICARE: HALEY GILES LCMHC

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	19545	NC

General Provider Information

NPI Number	:	1780455519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY GILES LCMHC

Provider Business Mailing Address
First Line	:	540 FORSYTHE ST
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-3765
Country	:	US
Telephone Number	:	910-750-2048
Fax Number	:

Provider Business Practice Location Address
First Line	:	2931 BREEZEWOOD AVE STE 104
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-5281
Country	:	US
Telephone Number	:	910-491-1134
Fax Number	:	910-491-1332

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

Provider Enumeration Date	:	01/10/2024
Last Update Date	:	03/25/2026

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