Provider Demographics
NPI:1639136195
Name:FLETCHER-HAINES, BILLIE J (LCSW)
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:J
Last Name:FLETCHER-HAINES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 ALLEGHENY ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-2028
Mailing Address - Country:US
Mailing Address - Phone:814-935-6920
Mailing Address - Fax:
Practice Address - Street 1:516 ALLEGHENY ST
Practice Address - Street 2:SUITE 106
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-2028
Practice Address - Country:US
Practice Address - Phone:814-935-6920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0136221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PW001509702OtherBCBS