Provider Demographics
NPI:1497900799
Name:HALEY, SHAWNA KEMP (EDD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:SHAWNA
Middle Name:KEMP
Last Name:HALEY
Suffix:
Gender:F
Credentials:EDD, LCSW
Other - Prefix:DR
Other - First Name:SHAWNA
Other - Middle Name:NICOLE
Other - Last Name:KEMP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:P.O. BOX 8904
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32239-8904
Mailing Address - Country:US
Mailing Address - Phone:904-412-3484
Mailing Address - Fax:
Practice Address - Street 1:4720 SALISBURY RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6101
Practice Address - Country:US
Practice Address - Phone:904-493-6116
Practice Address - Fax:904-493-6117
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL.C.S.W.1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical