Provider Demographics
NPI:1700592771
Name:KNOBLOCK, HAILEIGH
Entity Type:Individual
Prefix:
First Name:HAILEIGH
Middle Name:
Last Name:KNOBLOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18009 JD WHITE RD
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-6121
Mailing Address - Country:US
Mailing Address - Phone:318-805-2035
Mailing Address - Fax:
Practice Address - Street 1:109 ONEAL CT
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-3803
Practice Address - Country:US
Practice Address - Phone:334-379-1043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician