Provider Demographics
NPI:1891058954
Name:HAYTER, MICHAEL EDWARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:HAYTER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:730 S VIEW DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-6600
Mailing Address - Country:US
Mailing Address - Phone:276-494-4466
Mailing Address - Fax:276-200-0460
Practice Address - Street 1:730 S VIEW DR
Practice Address - Street 2:SUITE B
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-6600
Practice Address - Country:US
Practice Address - Phone:276-494-4466
Practice Address - Fax:276-200-0460
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA09040079731041C0700X
VA0710102250101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)