Healthcare Provider Details

I. General information

NPI: 1588028187
Provider Name (Legal Business Name): GERALD LYNN HAYES ED.D., LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2016
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3608 MELCHER ST SE
ROANOKE VA
24014-6414
US

IV. Provider business mailing address

3608 MELCHER ST SE
ROANOKE VA
24014-6414
US

V. Phone/Fax

Practice location:
  • Phone: 804-497-4676
  • Fax:
Mailing address:
  • Phone: 804-497-4676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701001323
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701001323
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: