Provider Demographics
NPI:1295466712
Name:HAINES, CANDICE MARIE
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:MARIE
Last Name:HAINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 PALMERSTON DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1024
Mailing Address - Country:US
Mailing Address - Phone:773-412-4893
Mailing Address - Fax:
Practice Address - Street 1:1760 S TELEGRAPH RD STE 103
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0180
Practice Address - Country:US
Practice Address - Phone:248-256-5209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010562101YM0800X
MI6401222429101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health