Healthcare Provider Details

I. General information

NPI: 1780868372
Provider Name (Legal Business Name): DAWN MARIE HAYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 GEYSER RD
BALLSTON SPA NY
12020-3022
US

IV. Provider business mailing address

67 SPIER FALLS RD
GANSEVOORT NY
12831-1006
US

V. Phone/Fax

Practice location:
  • Phone: 518-885-6884
  • Fax:
Mailing address:
  • Phone: 518-636-2233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: