Provider Demographics
NPI:1710526843
Name:MILES HAYNES, JAMIE M (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:M
Last Name:MILES HAYNES
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:M
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:4295 GARDENVIEW DR APT 211
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-1648
Mailing Address - Country:US
Mailing Address - Phone:404-285-3763
Mailing Address - Fax:
Practice Address - Street 1:4295 GARDENVIEW DR APT 211
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-1648
Practice Address - Country:US
Practice Address - Phone:404-285-3763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009361101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional