Provider Demographics
NPI:1548936784
Name:JACKSON, HALEY (MS, LMHC, LCMHC)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MS, LMHC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 CARMEL EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE 155
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-8242
Mailing Address - Country:US
Mailing Address - Phone:828-350-1177
Mailing Address - Fax:
Practice Address - Street 1:7400 CARMEL EXECUTIVE PARK DR
Practice Address - Street 2:SUITE 155
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8242
Practice Address - Country:US
Practice Address - Phone:828-350-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014125101YM0800X
NC20182101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health