Provider Demographics
NPI:1487133708
Name:WILSON, HALEY MCKENZIE DUKE
Entity type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:MCKENZIE DUKE
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:HALEY
Other - Middle Name:MCKENZIE DUKE
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4044 HWY 49 WEST
Mailing Address - Street 2:
Mailing Address - City:VANLEER
Mailing Address - State:TN
Mailing Address - Zip Code:37181
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1820 MEMORIAL CIR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4539
Practice Address - Country:US
Practice Address - Phone:931-920-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health