Provider Demographics
NPI:1740023365
Name:HAYES, DOMINQUE (LCMHCA)
Entity type:Individual
Prefix:
First Name:DOMINQUE
Middle Name:
Last Name:HAYES
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:DOMINQUE
Other - Middle Name:
Other - Last Name:ASHLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2587 RAVENHILL DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5451
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:609 ATTAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-1984
Practice Address - Country:US
Practice Address - Phone:919-567-0684
Practice Address - Fax:910-483-2026
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18995101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health