Provider Demographics
NPI:1487496642
Name:BROWN, HALEY SHAWN HICKS (ALC)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:SHAWN HICKS
Last Name:BROWN
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SHORT TRACK DR
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:AL
Mailing Address - Zip Code:35761-7929
Mailing Address - Country:US
Mailing Address - Phone:256-808-7299
Mailing Address - Fax:
Practice Address - Street 1:2227 DRAKE AVE SW STE 10D
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-5192
Practice Address - Country:US
Practice Address - Phone:256-203-6542
Practice Address - Fax:256-715-5029
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04431101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty