Provider Demographics
NPI:1346540481
Name:HAYNES, CATHY ANN
Entity Type:Individual
Prefix:MS
First Name:CATHY
Middle Name:ANN
Last Name:HAYNES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CATHYANN
Other - Middle Name:SELENA
Other - Last Name:HAYNES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2075 CALVERT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-1553
Mailing Address - Country:US
Mailing Address - Phone:313-282-2924
Mailing Address - Fax:
Practice Address - Street 1:9600 DEXTER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-1816
Practice Address - Country:US
Practice Address - Phone:313-894-4879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)