Provider Demographics
NPI:1417298449
Name:HAYWARD, ANDREA LEIGH (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEIGH
Last Name:HAYWARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17105 KENTON DR
Mailing Address - Street 2:SUITE 205C
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-5653
Mailing Address - Country:US
Mailing Address - Phone:704-727-6297
Mailing Address - Fax:
Practice Address - Street 1:17105 KENTON DR
Practice Address - Street 2:SUITE 205C
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5653
Practice Address - Country:US
Practice Address - Phone:704-727-6297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-15
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0094191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3410217Medicaid
NC6003176Medicaid