Provider Demographics
NPI:1518610971
Name:DAVIS, HALEY MADISON
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:MADISON
Last Name:DAVIS
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 1:2701 HOMESTEAD RD APT 603
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-8755
Mailing Address - Country:US
Mailing Address - Phone:252-333-0367
Mailing Address - Fax:
Practice Address - Street 1:50101 GOVERNORS DR STE 170
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-9257
Practice Address - Country:US
Practice Address - Phone:919-589-4523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCBFP10474585500OtherBLUECROSS BLUESHIELD