Provider Demographics
NPI:1578770772
Name:HALEY, AMORY HICKS (LCSW)
Entity Type:Individual
Prefix:
First Name:AMORY
Middle Name:HICKS
Last Name:HALEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMORY
Other - Middle Name:JEAN
Other - Last Name:HALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4011 GARDINER POINT DR STE 101
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1988
Mailing Address - Country:US
Mailing Address - Phone:502-451-5121
Mailing Address - Fax:502-451-5125
Practice Address - Street 1:4011 GARDINER POINT DR STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1988
Practice Address - Country:US
Practice Address - Phone:502-451-5121
Practice Address - Fax:502-451-5125
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1988104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker