Basic Information
| Provider Information | |||||||||
| NPI: | 1427538909 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAINES | ||||||||
| FirstName: | HALEY | ||||||||
| MiddleName: | SABRINA | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16103 PENN STATE RD | ||||||||
| Address2: | |||||||||
| City: | WEEKI WACHEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346141015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522329959 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2210 CR 528 | ||||||||
| Address2: | |||||||||
| City: | SUMTERVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335855214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525694252 | ||||||||
| FaxNumber: | 3523142909 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2018 | ||||||||
| LastUpdateDate: | 03/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-22-58586 | Y | Behavioral Health & Social Service Providers | Behavioral Analyst | 106S00000X | N |
ID Information
| ID | Type | State | Issuer | Description | 017486800 | 05 | FL | MEDICAID |