Provider Demographics
NPI:1659862118
Name:YOUNG, HALEY ALYSSA (BSW)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:ALYSSA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COLGATE CIR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23664-1813
Mailing Address - Country:US
Mailing Address - Phone:757-324-6362
Mailing Address - Fax:
Practice Address - Street 1:1130 TABB ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-3434
Practice Address - Country:US
Practice Address - Phone:757-800-5231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician