Healthcare Provider Details

I. General information

NPI: 1336427632
Provider Name (Legal Business Name): JAMES RONALD HAYNES JR. LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 N EUGENE ST
GREENSBORO NC
27401-1608
US

IV. Provider business mailing address

815 N EUGENE ST
GREENSBORO NC
27401-1608
US

V. Phone/Fax

Practice location:
  • Phone: 434-942-1161
  • Fax:
Mailing address:
  • Phone: 434-942-1161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14257
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number14257
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701004483
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: