Provider Demographics
NPI:1356182828
Name:LLEWELLYN, HALEY B (RCSWI)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:B
Last Name:LLEWELLYN
Suffix:
Gender:F
Credentials:RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2898 MAHAN DR STE 5
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5462
Mailing Address - Country:US
Mailing Address - Phone:850-552-0691
Mailing Address - Fax:
Practice Address - Street 1:2898 MAHAN DR STE 5
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5462
Practice Address - Country:US
Practice Address - Phone:850-552-0691
Practice Address - Fax:850-656-8969
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW204641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical