Provider Demographics
NPI:1952177453
Name:LANDRY, HALEY
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:LANDRY
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 1:1130 HAMPTON RIVERS RD UNIT 104
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-9299
Mailing Address - Country:US
Mailing Address - Phone:678-572-8586
Mailing Address - Fax:
Practice Address - Street 1:115 EAST AGUSTA ST
Practice Address - Street 2:
Practice Address - City:MCCORMICK
Practice Address - State:SC
Practice Address - Zip Code:29835
Practice Address - Country:US
Practice Address - Phone:813-926-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician