Provider Demographics
NPI:1114316007
Name:HAYES, JANE KELLETT (PHD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:KELLETT
Last Name:HAYES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W MIMOSA DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-3263
Mailing Address - Country:US
Mailing Address - Phone:770-997-7070
Mailing Address - Fax:
Practice Address - Street 1:102 W MIMOSA DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-3263
Practice Address - Country:US
Practice Address - Phone:770-997-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2023-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003845101YP2500X
SC8076101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional