Provider Demographics
NPI:1093764128
Name:CAROLYN BRENNAN HAINES, PH.D., P.C.
Entity Type:Organization
Organization Name:CAROLYN BRENNAN HAINES, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:BRENNAN
Authorized Official - Last Name:HAINES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-285-4594
Mailing Address - Street 1:1112 CROSSWAY LN
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-6855
Mailing Address - Country:US
Mailing Address - Phone:919-285-4584
Mailing Address - Fax:
Practice Address - Street 1:1112 CROSSWAY LN
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-6855
Practice Address - Country:US
Practice Address - Phone:919-285-4584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8472103TC1900X
NC3509305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty