Provider Demographics
NPI:1790125185
Name:HALEY'S MIND OF CARE SERVICES, LLC
Entity Type:Organization
Organization Name:HALEY'S MIND OF CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:NORFLEET-HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-423-4109
Mailing Address - Street 1:12801 OLD FORT RD
Mailing Address - Street 2:STE. 303
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-2844
Mailing Address - Country:US
Mailing Address - Phone:240-429-5390
Mailing Address - Fax:240-260-0743
Practice Address - Street 1:12801 OLD FORT RD
Practice Address - Street 2:STE. 303
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-2844
Practice Address - Country:US
Practice Address - Phone:240-429-5390
Practice Address - Fax:240-260-0743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-28
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD131121041C0700X
DCLC3028081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD741080Medicaid