Provider Demographics
NPI:1306389978
Name:HAYLES, KENYA
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:
Last Name:HAYLES
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 1:5115 FICUS TREE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-4384
Mailing Address - Country:US
Mailing Address - Phone:704-497-8594
Mailing Address - Fax:855-345-0943
Practice Address - Street 1:331 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-5383
Practice Address - Country:US
Practice Address - Phone:704-497-8594
Practice Address - Fax:855-345-0943
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker