Provider Demographics
NPI:1215147228
Name:HAYES, LORI S (CAS II)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:S
Last Name:HAYES
Suffix:
Gender:F
Credentials:CAS II
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3340 KEMPER ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-4907
Mailing Address - Country:US
Mailing Address - Phone:619-224-1673
Mailing Address - Fax:619-224-2538
Practice Address - Street 1:3340 KEMPER ST STE 103
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4907
Practice Address - Country:US
Practice Address - Phone:619-224-1673
Practice Address - Fax:619-224-2538
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01-023572101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01-023572OtherCAS CERTIFICATION