Provider Demographics
NPI:1336427632
Name:HAYNES, JAMES RONALD JR (LPC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RONALD
Last Name:HAYNES
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 N EUGENE ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1608
Mailing Address - Country:US
Mailing Address - Phone:434-942-1161
Mailing Address - Fax:
Practice Address - Street 1:815 N EUGENE ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1608
Practice Address - Country:US
Practice Address - Phone:434-942-1161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004483101YP2500X
NC14257101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional