Healthcare Provider Details

I. General information

NPI: 1023139037
Provider Name (Legal Business Name): ELIZABETH J HAYES MA,LMHC,LCDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CODAC INC 93 THAMES ST
NEWPORT RI
02840
US

IV. Provider business mailing address

58 STEWART DR
PORTSMOUTH RI
02871-3713
US

V. Phone/Fax

Practice location:
  • Phone: 401-846-4150
  • Fax:
Mailing address:
  • Phone: 401-683-4513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMHC00161
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: