Healthcare Provider Details

I. General information

NPI: 1548411481
Provider Name (Legal Business Name): KATINA HAYNES MBA, SWT,FAODP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20300 SUPERIOR RD STE 200
TAYLOR MI
48180-6303
US

IV. Provider business mailing address

4127 10TH ST
ECORSE MI
48229-1211
US

V. Phone/Fax

Practice location:
  • Phone: 734-785-7700
  • Fax:
Mailing address:
  • Phone: 313-799-8519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6803078256
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: