Provider Demographics
NPI:1669816021
Name:PROVIDENCE PSYCHIATRIC & BEHAVIORAL HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:PROVIDENCE PSYCHIATRIC & BEHAVIORAL HEALTH SERVICES, INC
Other - Org Name:HELEN B. HAYES,FNP-BC, PMHNP-BC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:BERNICE
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC, PMHNP-BC
Authorized Official - Phone:704-907-2934
Mailing Address - Street 1:PO BOX 79254
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28271-7061
Mailing Address - Country:US
Mailing Address - Phone:704-907-2934
Mailing Address - Fax:
Practice Address - Street 1:4822 ALBEMARLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6668
Practice Address - Country:US
Practice Address - Phone:704-907-2934
Practice Address - Fax:704-532-5948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-28
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201021363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty