Provider Demographics
NPI:1083330161
Name:MAGNICHERI, HAYLEE LAUREN (EDS, LPC, RPT)
Entity type:Individual
Prefix:
First Name:HAYLEE
Middle Name:LAUREN
Last Name:MAGNICHERI
Suffix:
Gender:F
Credentials:EDS, LPC, RPT
Other - Prefix:
Other - First Name:HAYLEE
Other - Middle Name:MAGNICHERI
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, LPC
Mailing Address - Street 1:279 SKYLARK DR
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30705-5564
Mailing Address - Country:US
Mailing Address - Phone:678-767-0340
Mailing Address - Fax:
Practice Address - Street 1:279 SKYLARK DR
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-5564
Practice Address - Country:US
Practice Address - Phone:678-767-0340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013242101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional