Provider Demographics
NPI:1508596933
Name:HALEY, MCKINSEY GRACE
Entity Type:Individual
Prefix:
First Name:MCKINSEY
Middle Name:GRACE
Last Name:HALEY
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 1:390 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-1528
Mailing Address - Country:US
Mailing Address - Phone:678-863-2112
Mailing Address - Fax:
Practice Address - Street 1:390 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-1528
Practice Address - Country:US
Practice Address - Phone:678-863-2112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker