Provider Demographics
NPI:1881411619
Name:HAYES, LATASHA NICOLE (LAC)
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:NICOLE
Last Name:HAYES
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 LANSDOWNE TER
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07062-2109
Mailing Address - Country:US
Mailing Address - Phone:973-955-3720
Mailing Address - Fax:
Practice Address - Street 1:1219 LANSDOWNE TER
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07062-2109
Practice Address - Country:US
Practice Address - Phone:973-955-3720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00815600106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist