Provider Demographics
NPI:1093136525
Name:HAYES, CHANTAL D (MA, LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:CHANTAL
Middle Name:D
Last Name:HAYES
Suffix:
Gender:F
Credentials:MA, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1348 WESTGATE CENTER DR STE 202
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2984
Mailing Address - Country:US
Mailing Address - Phone:336-448-4451
Mailing Address - Fax:
Practice Address - Street 1:1348 WESTGATE CENTER DR STE 202
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2984
Practice Address - Country:US
Practice Address - Phone:336-448-4451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-31
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9282101Y00000X, 101YM0800X
NCA9282101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional