Healthcare Provider Details

I. General information

NPI: 1891058954
Provider Name (Legal Business Name): MICHAEL EDWARD HAYTER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 S VIEW DR SUITE B
MARION VA
24354-6600
US

IV. Provider business mailing address

730 S VIEW DR SUITE B
MARION VA
24354-6600
US

V. Phone/Fax

Practice location:
  • Phone: 276-494-4466
  • Fax: 276-200-0460
Mailing address:
  • Phone: 276-494-4466
  • Fax: 276-200-0460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0710102250
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904007973
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: