Provider Demographics
NPI:1376049171
Name:HAYWOOD, ADRIAN TOLLIVER
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:TOLLIVER
Last Name:HAYWOOD
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 1:4147 GLASS LANTERN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-3063
Mailing Address - Country:US
Mailing Address - Phone:702-340-9456
Mailing Address - Fax:
Practice Address - Street 1:4147 GLASS LANTERN DR
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-3063
Practice Address - Country:US
Practice Address - Phone:702-340-9456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst