Healthcare Provider Details

I. General information

NPI: 1467564997
Provider Name (Legal Business Name): MICHAEL HANEY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 20TH ST
HUNTINGTON WV
25703-1850
US

IV. Provider business mailing address

3339 PINEHAVEN DR
ASHLAND KY
41101-4931
US

V. Phone/Fax

Practice location:
  • Phone: 304-696-8700
  • Fax:
Mailing address:
  • Phone: 606-923-8438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00939800
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3485
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: