Provider Demographics
NPI:1164159695
Name:MILHOLLAND, HALEY DAWN (LCSW)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:DAWN
Last Name:MILHOLLAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:DAWN
Other - Last Name:HITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8905 BRAGG RD
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47341-9769
Mailing Address - Country:US
Mailing Address - Phone:765-499-7539
Mailing Address - Fax:
Practice Address - Street 1:8905 BRAGG RD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN CITY
Practice Address - State:IN
Practice Address - Zip Code:47341-9769
Practice Address - Country:US
Practice Address - Phone:765-499-7539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34009833A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical