Provider Demographics
NPI:1457655722
Name:HAYNES, TAMARA (LPC)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:HAYNES
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 RYE BROOK BLVD NE UNIT 416
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-7147
Mailing Address - Country:US
Mailing Address - Phone:980-257-5530
Mailing Address - Fax:
Practice Address - Street 1:1608 QUEEN ST STE 111
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-5527
Practice Address - Country:US
Practice Address - Phone:980-257-5530
Practice Address - Fax:888-391-4375
Is Sole Proprietor?:No
Enumeration Date:2010-12-30
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8430101Y00000X
NC8430101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor