Healthcare Provider Details

I. General information

NPI: 1649236878
Provider Name (Legal Business Name): STEPHEN SCOTT HAIGLEY LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 10/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 CHESTNUT AVE THE MILL CENTRE, SUITE 204
BALTIMORE MD
21211-2727
US

IV. Provider business mailing address

5220 DOWNING RD
BALTIMORE MD
21212-4114
US

V. Phone/Fax

Practice location:
  • Phone: 410-262-1146
  • Fax: 410-741-3817
Mailing address:
  • Phone: 410-262-1146
  • Fax: 410-741-3817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number333
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC1125
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: