Provider Demographics
NPI:1376189548
Name:HAYES, KADEISHA LANORA
Entity Type:Individual
Prefix:
First Name:KADEISHA
Middle Name:LANORA
Last Name:HAYES
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 1:6169 US HIGHWAY 11
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35146-4056
Mailing Address - Country:US
Mailing Address - Phone:205-207-2066
Mailing Address - Fax:
Practice Address - Street 1:6169 US HIGHWAY 11
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:AL
Practice Address - Zip Code:35146-4056
Practice Address - Country:US
Practice Address - Phone:205-207-2066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19-101564103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst