Healthcare Provider Details

I. General information

NPI: 1841153871
Provider Name (Legal Business Name): ISLAND MENTAL HEALTH SERVICES LICENSED CLINICAL SOCIAL WORKER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2881 MEADOW DR
LAKEPORT CA
95453-9616
US

IV. Provider business mailing address

2881 MEADOW DR
LAKEPORT CA
95453-9616
US

V. Phone/Fax

Practice location:
  • Phone: 707-510-9330
  • Fax:
Mailing address:
  • Phone: 707-510-9330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LAYLA HAYES
Title or Position: PRESIDENT
Credential: LCSW
Phone: 707-510-9330