Provider Demographics
NPI:1366281339
Name:GEORGE, HAILEY N
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:N
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12498 EQUINE LN
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3508
Mailing Address - Country:US
Mailing Address - Phone:561-906-7614
Mailing Address - Fax:
Practice Address - Street 1:6420 MELALEUCA LN
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3807
Practice Address - Country:US
Practice Address - Phone:561-286-5340
Practice Address - Fax:888-385-6227
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH25816101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health