Provider Demographics
NPI:1528164001
Name:HANEY, PRISCILLA HILL (LCSW)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:HILL
Last Name:HANEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:HANEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:121 SEA GROVE MAIN ST UNIT 201
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-3303
Mailing Address - Country:US
Mailing Address - Phone:904-347-4403
Mailing Address - Fax:904-471-0639
Practice Address - Street 1:2225 A1A S STE B5
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-7906
Practice Address - Country:US
Practice Address - Phone:904-347-4403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW6996101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL685776100Medicaid