Provider Demographics
NPI:1720719503
Name:DAVIS, HALEY R (LCSW)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:R
Last Name:DAVIS
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 1:1723 MAHAN CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5428
Mailing Address - Country:US
Mailing Address - Phone:850-446-1077
Mailing Address - Fax:850-312-4352
Practice Address - Street 1:1669 MAHAN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5454
Practice Address - Country:US
Practice Address - Phone:850-446-1077
Practice Address - Fax:850-312-4352
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW200821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty