Healthcare Provider Details

I. General information

NPI: 1831023571
Provider Name (Legal Business Name): HAILLIEY THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 N KING ST
HAMPTON VA
23669-1909
US

IV. Provider business mailing address

148 HARRINGTON RD
NEWPORT NEWS VA
23602-6432
US

V. Phone/Fax

Practice location:
  • Phone: 757-792-9596
  • Fax:
Mailing address:
  • Phone: 646-603-9151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: