MEDICARE: DR HALEY'S SOCIAL SKILLS CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	0810002757	VA

General Provider Information

NPI Number	:	1134460306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR HALEY'S SOCIAL SKILLS CENTER

Provider Business Mailing Address
First Line	:	13885 HEDGEWOOD DR STE 233
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-7931
Country	:	US
Telephone Number	:	571-285-1403
Fax Number	:	703-490-4525

Provider Business Practice Location Address
First Line	:	13885 HEDGEWOOD DR STE 233
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-7931
Country	:	US
Telephone Number	:	571-285-1403
Fax Number	:	703-490-4525

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHRISTOPHER HALEY
Credential	:	PSY.D.
Telephone Number	:	571-285-1403

Provider Enumeration Date	:	03/12/2013
Last Update Date	:	03/12/2013

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