Provider Demographics
NPI:1881647451
Name:HAYNES, TITUS (LCSW)
Entity Type:Individual
Prefix:
First Name:TITUS
Middle Name:
Last Name:HAYNES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8360 SIX FORKS RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-5077
Mailing Address - Country:US
Mailing Address - Phone:919-848-0132
Mailing Address - Fax:919-848-0277
Practice Address - Street 1:8360 SIX FORKS RD
Practice Address - Street 2:SUITE 202
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5077
Practice Address - Country:US
Practice Address - Phone:919-848-0132
Practice Address - Fax:919-848-0277
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0034881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003339Medicaid