Provider Demographics
NPI:1275902686
Name:HAYTER, ROBBIE
Entity Type:Individual
Prefix:
First Name:ROBBIE
Middle Name:
Last Name:HAYTER
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 1:3317 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37090-8065
Mailing Address - Country:US
Mailing Address - Phone:615-592-6365
Mailing Address - Fax:949-655-5878
Practice Address - Street 1:3317 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-8065
Practice Address - Country:US
Practice Address - Phone:615-424-3742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW6363104100000X
TN65761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker