Provider Demographics
NPI:1659651784
Name:HAYNES, CHANDA V (LPC)
Entity type:Individual
Prefix:MS
First Name:CHANDA
Middle Name:V
Last Name:HAYNES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2613 NE OVERLOOK DR APT 931
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7651
Mailing Address - Country:US
Mailing Address - Phone:971-270-5432
Mailing Address - Fax:
Practice Address - Street 1:2333 LINDSEY DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-2937
Practice Address - Country:US
Practice Address - Phone:502-807-3229
Practice Address - Fax:502-448-8760
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-20
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005650101YP2500X
ORC6181101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional