Provider Demographics
NPI:1679610018
Name:HAINES, SUSAN MAWDESLEY (MS, CDS III, NCGC II)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MAWDESLEY
Last Name:HAINES
Suffix:
Gender:F
Credentials:MS, CDS III, NCGC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-4713
Mailing Address - Country:US
Mailing Address - Phone:503-636-5039
Mailing Address - Fax:
Practice Address - Street 1:131 NE 102ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4167
Practice Address - Country:US
Practice Address - Phone:503-253-6754
Practice Address - Fax:503-253-8020
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health