Healthcare Provider Details

I. General information

NPI: 1114290558
Provider Name (Legal Business Name): WAYNE A. HAINES LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 W STATE ST
BELDING MI
48809-9217
US

IV. Provider business mailing address

321 ALDERMAN ST
BELDING MI
48809-1705
US

V. Phone/Fax

Practice location:
  • Phone: 616-666-0206
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401012790
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: