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General NPI Number Information
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NPI Number | 1598526238
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Entity Type | Individual
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Provider Name | JALISA HAYES BSW
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Gender | Female
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Dates
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Enumeration Date | 01/19/2024
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 305 E 3RD ST
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City | PEMBROKE
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State | NC
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Zip | 28372-7991
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Country | US
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Telephone | 910-521-7461
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2844
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City | PEMBROKE
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State | NC
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Zip | 28372-2844
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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