Provider Demographics
NPI:1881719169
Name:HAYWARD, ROSEMARY ALIDA (MS LPC)
Entity type:Individual
Prefix:MRS
First Name:ROSEMARY
Middle Name:ALIDA
Last Name:HAYWARD
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 GOULD LANE
Mailing Address - Street 2:
Mailing Address - City:JEKYLL ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31527-0634
Mailing Address - Country:US
Mailing Address - Phone:912-638-6899
Mailing Address - Fax:912-635-2036
Practice Address - Street 1:228 REDFERN VILLAGE SUITE 205
Practice Address - Street 2:
Practice Address - City:ST SIMON ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-7741
Practice Address - Country:US
Practice Address - Phone:912-638-6899
Practice Address - Fax:912-635-2036
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAH001646101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
52503037002OtherBLUE CROSS BLUE SHIELD