Provider Demographics
NPI:1093274052
Name:DOVE, HAELI
Entity Type:Individual
Prefix:
First Name:HAELI
Middle Name:
Last Name:DOVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 DARLINGTON AVE UNIT 105
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1370
Mailing Address - Country:US
Mailing Address - Phone:919-671-9907
Mailing Address - Fax:
Practice Address - Street 1:353 DARLINGTON AVE UNIT 105
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1370
Practice Address - Country:US
Practice Address - Phone:919-671-9907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician