MEDICARE: MS. CONNIE LEE HAYES LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	3192	NC

General Provider Information

NPI Number	:	1538387576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CONNIE LEE HAYES LPC, NCC

Provider Business Mailing Address
First Line	:	3201 SELWYN AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3323
Country	:	US
Telephone Number	:	704-617-4439
Fax Number	:	704-523-1878

Provider Business Practice Location Address
First Line	:	1373 E MOREHEAD ST STE 12
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2900
Country	:	US
Telephone Number	:	704-617-4439
Fax Number	:	704-523-1878

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/08/2007

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