Healthcare Provider Details

I. General information

NPI: 1609555671
Provider Name (Legal Business Name): HALEY ANTHONY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 PLEASANT HOME RD
AUGUSTA GA
30907-0518
US

IV. Provider business mailing address

272 WALNUT LN
NORTH AUGUSTA SC
29860-9215
US

V. Phone/Fax

Practice location:
  • Phone: 706-364-4599
  • Fax: 706-364-4589
Mailing address:
  • Phone: 803-645-4630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC014034
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: