Provider Demographics
NPI:1124412804
Name:HAYES, ALEXIS CHIVON
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:CHIVON
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 1:1084 GERSHAL AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSGROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:08318-4117
Mailing Address - Country:US
Mailing Address - Phone:856-275-4043
Mailing Address - Fax:
Practice Address - Street 1:1084 GERSHAL AVE
Practice Address - Street 2:
Practice Address - City:PITTSGROVE
Practice Address - State:NJ
Practice Address - Zip Code:08318-4117
Practice Address - Country:US
Practice Address - Phone:856-275-4043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health