Provider Demographics
NPI:1447631080
Name:HAYES, ROGER (CADC I)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:HAYES
Suffix:
Gender:M
Credentials:CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 N HIGHWAY 101
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146-9371
Mailing Address - Country:US
Mailing Address - Phone:503-335-0241
Mailing Address - Fax:
Practice Address - Street 1:65 N HIGHWAY 101
Practice Address - Street 2:SUITE 204
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146-9371
Practice Address - Country:US
Practice Address - Phone:503-325-5722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR15-08-09OtherCADC I