Provider Demographics
NPI:1790298768
Name:GRESHAM, HALEY AUGUSTA (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:AUGUSTA
Last Name:GRESHAM
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 MCDONALD RD
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-2706
Mailing Address - Country:US
Mailing Address - Phone:770-845-3666
Mailing Address - Fax:
Practice Address - Street 1:105 GOVERNORS SQ STE E
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4866
Practice Address - Country:US
Practice Address - Phone:770-845-3666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALMFT001591106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist