Provider Demographics
NPI:1174878649
Name:HAYTER, VICKYE (RN, LGMFT)
Entity type:Individual
Prefix:
First Name:VICKYE
Middle Name:
Last Name:HAYTER
Suffix:
Gender:F
Credentials:RN, LGMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E WEST HWY
Mailing Address - Street 2:THRIVE CENTER
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3230
Mailing Address - Country:US
Mailing Address - Phone:301-221-7360
Mailing Address - Fax:
Practice Address - Street 1:1400 E WEST HWY
Practice Address - Street 2:THRIVE CENTER
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3230
Practice Address - Country:US
Practice Address - Phone:301-221-7360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGM562106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist