Provider Demographics
NPI:1336657402
Name:HAYNAM, MICHELE ANGELA (LPC, NCC, CSOTP, CSA)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:ANGELA
Last Name:HAYNAM
Suffix:
Gender:F
Credentials:LPC, NCC, CSOTP, CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 EATON STREET
Mailing Address - Street 2:SUITE 1103
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 EATON ST
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-4054
Practice Address - Country:US
Practice Address - Phone:757-513-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0812000773101YM0800X
VA0701007399101YP2500X
VA0710103135101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty