Provider Demographics
NPI:1538116603
Name:HAYES, TERESE NICOLE (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:TERESE
Middle Name:NICOLE
Last Name:HAYES
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MS
Other - First Name:TERESE
Other - Middle Name:NICOLE
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:PO BOX 882
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871
Mailing Address - Country:US
Mailing Address - Phone:301-972-1373
Mailing Address - Fax:301-972-1584
Practice Address - Street 1:13241 EXECUTIVE PARK TER
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2648
Practice Address - Country:US
Practice Address - Phone:301-972-1373
Practice Address - Fax:301-972-1584
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD126371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408867100Medicaid
MD408867100Medicaid