Provider Demographics
NPI:1598496804
Name:CAMPBELL, HALEY NICOLE (MA)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:NICOLE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:NICOLE
Other - Last Name:DAVLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:11416 SLATER AVE NE STE 100
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-4600
Mailing Address - Country:US
Mailing Address - Phone:206-853-7364
Mailing Address - Fax:
Practice Address - Street 1:5146 SLATE CT SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-4300
Practice Address - Country:US
Practice Address - Phone:904-518-8067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-19
Last Update Date:2022-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG61314343.106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist