Provider Demographics
NPI:1699252817
Name:HAYNES, WILLISHA (SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:WILLISHA
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 RUSHTON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3739
Mailing Address - Country:US
Mailing Address - Phone:216-301-0868
Mailing Address - Fax:
Practice Address - Street 1:1701 RUSHTON RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-3739
Practice Address - Country:US
Practice Address - Phone:216-301-0868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical