Provider Demographics
NPI:1114382736
Name:HAYES, RAVEN
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:
Last Name:HAYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 METRO DR STE G
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3446
Mailing Address - Country:US
Mailing Address - Phone:318-445-9019
Mailing Address - Fax:318-445-1098
Practice Address - Street 1:1403 METRO DR STE G
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3446
Practice Address - Country:US
Practice Address - Phone:318-445-9019
Practice Address - Fax:318-445-1098
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-25
Last Update Date:2015-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health