Provider Demographics
NPI:1215412093
Name:HAYNES, ADRIA D (LMSW)
Entity type:Individual
Prefix:
First Name:ADRIA
Middle Name:D
Last Name:HAYNES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:
Other - Last Name:AMOROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5506 TORREY RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-5955
Mailing Address - Country:US
Mailing Address - Phone:810-516-6601
Mailing Address - Fax:
Practice Address - Street 1:G-4413 CORUNNA RD.
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532
Practice Address - Country:US
Practice Address - Phone:810-516-6601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801100166104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801100166OtherLICENCE NUMBER