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General NPI Number Information
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NPI Number | 1366406209
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Entity Type | Individual
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Provider Name | WILLIAM EUGENE HAEFNER MSW, LCSW
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Gender | Male
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Dates
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Enumeration Date | 04/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 100 EMANCIPATION DR
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City | HAMPTON
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State | VA
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Zip | 23667-0001
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Country | US
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Telephone | 757-722-9961
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Fax | 757-728-3174
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Provider Business Mailing Address
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Address Line | 803 WESTGATE CT
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City | NEWPORT NEWS
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State | VA
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Zip | 23602-9603
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Country | US
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Telephone | 757-988-0939
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904003504
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License Number State | VA
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