Provider Demographics
NPI:1366214009
Name:EDWARDS, HALEY (CCLS)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:CCLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 PHILBATE TER
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-5734
Mailing Address - Country:US
Mailing Address - Phone:804-381-1927
Mailing Address - Fax:
Practice Address - Street 1:428 PHILBATE TER
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-5734
Practice Address - Country:US
Practice Address - Phone:804-381-1927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA24604174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist