Provider Demographics
NPI:1851524912
Name:JACKSON-HAYES, RUTH CLARIE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:CLARIE
Last Name:JACKSON-HAYES
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 BELAIR DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-2102
Mailing Address - Country:US
Mailing Address - Phone:301-675-9123
Mailing Address - Fax:
Practice Address - Street 1:2908 BELAIR DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-2102
Practice Address - Country:US
Practice Address - Phone:301-675-9123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC629101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional