Provider Demographics
NPI:1780186239
Name:ROBERTS, HALEY ELIZABETH (LICSW)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:ELIZABETH
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:ELIZABETH
Other - Last Name:HAYNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 742
Mailing Address - Street 2:
Mailing Address - City:ATTALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35954-0742
Mailing Address - Country:US
Mailing Address - Phone:256-344-3116
Mailing Address - Fax:
Practice Address - Street 1:309 CASE AVE SE
Practice Address - Street 2:
Practice Address - City:ATTALLA
Practice Address - State:AL
Practice Address - Zip Code:35954-3408
Practice Address - Country:US
Practice Address - Phone:256-344-3116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5682B101YA0400X
AL4682G104100000X
AL5342C101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker