Provider Demographics
NPI:1346734977
Name:HEATLEY, KAELEIGH (LLMSW)
Entity Type:Individual
Prefix:
First Name:KAELEIGH
Middle Name:
Last Name:HEATLEY
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5572 ARBOR BAY CT
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-7783
Mailing Address - Country:US
Mailing Address - Phone:810-623-6399
Mailing Address - Fax:
Practice Address - Street 1:6548 TOWN CENTER DR STE D
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-4823
Practice Address - Country:US
Practice Address - Phone:248-422-1430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851115054104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker