Provider Demographics
NPI:1992941090
Name:HAYNES, VICKI MARIA (QP)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:MARIA
Last Name:HAYNES
Suffix:
Gender:F
Credentials:QP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12033 RED LEAF DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-1002
Mailing Address - Country:US
Mailing Address - Phone:704-537-8728
Mailing Address - Fax:
Practice Address - Street 1:12033 RED LEAF DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-1002
Practice Address - Country:US
Practice Address - Phone:704-537-8728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-20
Last Update Date:2008-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral