Provider Demographics
NPI:1336797596
Name:WATERS, HALEY NICOLE (MS)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:NICOLE
Last Name:WATERS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:NICOLE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:217 PINE LOG RD
Mailing Address - Street 2:
Mailing Address - City:BEECH ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29842-8308
Mailing Address - Country:US
Mailing Address - Phone:706-840-4032
Mailing Address - Fax:
Practice Address - Street 1:916 REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812-6358
Practice Address - Country:US
Practice Address - Phone:803-259-7170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health