Provider Demographics
NPI:1346752458
Name:HAYES, KELLY MACKENZIE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MACKENZIE
Last Name:HAYES
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8716 SATYR HILL RD
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-2826
Mailing Address - Country:US
Mailing Address - Phone:443-461-4596
Mailing Address - Fax:
Practice Address - Street 1:8716 SATYR HILL RD
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-2826
Practice Address - Country:US
Practice Address - Phone:443-461-4596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2023-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD194201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical