Provider Demographics
NPI:1154051985
Name:HAYZE, JUSTICE
Entity Type:Individual
Prefix:MISS
First Name:JUSTICE
Middle Name:
Last Name:HAYZE
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 1:366 GILBERT AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-3208
Mailing Address - Country:US
Mailing Address - Phone:404-234-9141
Mailing Address - Fax:
Practice Address - Street 1:7400 W CAMPUS RD # 43054
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-8722
Practice Address - Country:US
Practice Address - Phone:937-284-1391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.185451101YA0400X, 171M00000X
101YM0800X
OHYPS.000023175T00000X
OHAPS.002598175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator