Provider Demographics
NPI:1487786547
Name:HAYES, EDWARD GILMOUR (LCSW)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:GILMOUR
Last Name:HAYES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10299 WOODMAN RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-4419
Mailing Address - Country:US
Mailing Address - Phone:804-727-8517
Mailing Address - Fax:804-727-8580
Practice Address - Street 1:4825 S LABURNUM AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23231-2713
Practice Address - Country:US
Practice Address - Phone:804-222-2607
Practice Address - Fax:804-236-9118
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040033291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2169318OtherMAMSI
VA219829OtherANTHEM
VAO89087OtherOPTIMA
VA4945131OtherVIRGINIA PREMIER
VA146625-000OtherMAGELLAN
VAP00301359OtherRAILROAD MEDICARE
VA219829OtherANTHEM