Provider Demographics
NPI:1245801208
Name:HALLEY, TIMOTHY (CDCA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:HALLEY
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550-9366
Mailing Address - Country:US
Mailing Address - Phone:304-593-8153
Mailing Address - Fax:
Practice Address - Street 1:14761 STATE ROUTE 93 UNIT 4
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-9820
Practice Address - Country:US
Practice Address - Phone:740-577-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH177473101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)