Provider Demographics
NPI:1003126608
Name:HAFFEY, AMY N (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:N
Last Name:HAFFEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15220 HIGHWAY 57
Mailing Address - Street 2:
Mailing Address - City:VANCLEAVE
Mailing Address - State:MS
Mailing Address - Zip Code:39565-6643
Mailing Address - Country:US
Mailing Address - Phone:616-826-4800
Mailing Address - Fax:888-887-2761
Practice Address - Street 1:2112 BIENVILLE BLVD STE M1
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3027
Practice Address - Country:US
Practice Address - Phone:616-826-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.08007951041C0700X
MSC88061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0268768Medicaid