Healthcare Provider Details

I. General information

NPI: 1174174254
Provider Name (Legal Business Name): HAYLEY MARIE ALKHAFAJI LMSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HAYLEY MARIE TURNER LMSW-C

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 S BROADWAY STE 18
MINOT ND
58701-4667
US

IV. Provider business mailing address

233 CANNELLE CT
CANTON MI
48187-4587
US

V. Phone/Fax

Practice location:
  • Phone: 701-857-8500
  • Fax: 701-857-8555
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5781
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801115598
License Number StateMI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: