Provider Demographics
NPI:1306183157
Name:HAYNES, DEIRDRE F (LPC)
Entity Type:Individual
Prefix:MS
First Name:DEIRDRE
Middle Name:F
Last Name:HAYNES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 FOREST DR
Mailing Address - Street 2:SUITE A-204
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-4146
Mailing Address - Country:US
Mailing Address - Phone:803-790-2025
Mailing Address - Fax:803-790-7010
Practice Address - Street 1:3800 FOREST DR
Practice Address - Street 2:SUITE A-204
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4146
Practice Address - Country:US
Practice Address - Phone:803-790-2025
Practice Address - Fax:803-790-7010
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5425101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC 5425Medicaid