Provider Demographics
NPI:1255146676
Name:HAYNES, CARLENE (RBT)
Entity type:Individual
Prefix:
First Name:CARLENE
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 JACOBS WALK
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:GA
Mailing Address - Zip Code:31635-5740
Mailing Address - Country:US
Mailing Address - Phone:803-720-1982
Mailing Address - Fax:
Practice Address - Street 1:406 JACKSON CIR
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:GA
Practice Address - Zip Code:31636-4928
Practice Address - Country:US
Practice Address - Phone:229-630-2086
Practice Address - Fax:888-843-2534
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-24-344516106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician