Healthcare Provider Details

I. General information

NPI: 1083418560
Provider Name (Legal Business Name): CHARYCE LAVETTE HAYNES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/03/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 E AMERICAN AVE
FRESNO CA
93725-9247
US

IV. Provider business mailing address

431 E TUOLUMNE ST
FRESNO CA
93706-2614
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-9180
  • Fax:
Mailing address:
  • Phone: 559-304-2146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW109721
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: