Provider Demographics
NPI:1619173358
Name:HAINES, LISA C (MS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:HAINES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BROAD ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3579
Mailing Address - Country:US
Mailing Address - Phone:919-286-9106
Mailing Address - Fax:919-286-4716
Practice Address - Street 1:1200 BROAD ST
Practice Address - Street 2:SUITE 209
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3579
Practice Address - Country:US
Practice Address - Phone:919-286-9106
Practice Address - Fax:919-286-4716
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist