Provider Demographics
NPI:1700057197
Name:HAYNES, CAROL LEE (LICSW MSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:LEE
Last Name:HAYNES
Suffix:
Gender:F
Credentials:LICSW MSW
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:LEE
Other - Last Name:ARIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19901 105TH PLACE NE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011
Mailing Address - Country:US
Mailing Address - Phone:206-818-1981
Mailing Address - Fax:
Practice Address - Street 1:11416 SLATER AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033
Practice Address - Country:US
Practice Address - Phone:206-818-1981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00004489104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker