Provider Demographics
NPI:1659651784
Name:HAYNES, CHANDA V (LPCA)
Entity Type:Individual
Prefix:MS
First Name:CHANDA
Middle Name:V
Last Name:HAYNES
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 LINDSEY DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-2937
Mailing Address - Country:US
Mailing Address - Phone:502-807-3229
Mailing Address - Fax:502-448-8760
Practice Address - Street 1:2333 LINDSEY DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-2937
Practice Address - Country:US
Practice Address - Phone:502-807-3229
Practice Address - Fax:502-448-8760
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-20
Last Update Date:2011-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0976101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional