Provider Demographics
NPI:1881255735
Name:HAYES, MELISSA DARLENE (A06500924)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DARLENE
Last Name:HAYES
Suffix:
Gender:
Credentials:A06500924
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:DARLENE
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:A06500924
Mailing Address - Street 1:1100 N D ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-3524
Mailing Address - Country:US
Mailing Address - Phone:909-884-0840
Mailing Address - Fax:
Practice Address - Street 1:349 W 11TH ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-3513
Practice Address - Country:US
Practice Address - Phone:562-716-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA065000924101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)