Provider Demographics
NPI:1174816219
Name:HAYES, LISA LOUISE (LISW-S)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LOUISE
Last Name:HAYES
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W 5TH AVE STE 102D
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-2503
Mailing Address - Country:US
Mailing Address - Phone:614-398-1283
Mailing Address - Fax:
Practice Address - Street 1:1200 W 5TH AVE STE 102D
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-2503
Practice Address - Country:US
Practice Address - Phone:614-398-1283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI09001631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical