Provider Demographics
NPI:1528326246
Name:BAYNE, AUTUMN RAY (LMSW)
Entity type:Individual
Prefix:MRS
First Name:AUTUMN
Middle Name:RAY
Last Name:BAYNE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 GLENHILL DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1069
Mailing Address - Country:US
Mailing Address - Phone:313-478-3438
Mailing Address - Fax:
Practice Address - Street 1:1003 GLENHILL DR
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1069
Practice Address - Country:US
Practice Address - Phone:313-478-3438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010939031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical