Provider Demographics
NPI:1629696984
Name:WASHAM, HAILEY MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:MARIE
Last Name:WASHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:BEEBE
Mailing Address - State:AR
Mailing Address - Zip Code:72012-3103
Mailing Address - Country:US
Mailing Address - Phone:501-882-5643
Mailing Address - Fax:870-933-9395
Practice Address - Street 1:1201 W CENTER ST
Practice Address - Street 2:
Practice Address - City:BEEBE
Practice Address - State:AR
Practice Address - Zip Code:72012-3103
Practice Address - Country:US
Practice Address - Phone:501-882-5463
Practice Address - Fax:501-882-3117
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR104100000X
ARPLMSW104100000X
AR9993-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker