Provider Demographics
NPI:1164684650
Name:HAINES, JENNY M (EDS, ABD)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:M
Last Name:HAINES
Suffix:
Gender:F
Credentials:EDS, ABD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 CAMERON CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-6880
Mailing Address - Country:US
Mailing Address - Phone:704-280-4707
Mailing Address - Fax:
Practice Address - Street 1:5113 PIPER STATION DR
Practice Address - Street 2:SUITE 207
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6689
Practice Address - Country:US
Practice Address - Phone:704-541-0424
Practice Address - Fax:704-541-4244
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6740101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional