Provider Demographics
NPI:1770299299
Name:HAYNES, MARIUS (MA)
Entity type:Individual
Prefix:
First Name:MARIUS
Middle Name:
Last Name:HAYNES
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 WOODMONT LN NW # 1576
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2866
Mailing Address - Country:US
Mailing Address - Phone:678-439-9804
Mailing Address - Fax:
Practice Address - Street 1:4850 SUGARLOAF PKWY STE 209-323
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-2859
Practice Address - Country:US
Practice Address - Phone:678-439-9804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health